Surveillance

Cocaine, methamphetamine, and spice are addictive, non-opioid substances that negatively impact a person's health through direct and indirect means. Direct health concerns of non-opioid substance use include anxiety, paranoia, seizure, heart attack, stroke, and potentially death while indirect health concerns include the acquisition of disease and infections, particularly sexually transmitted infections (STIs). Substance users experience an increased risk of acquiring STIs since they may exchange sex for substances, use substances within a social setting that may lead to sexual activity, or engage in risky sexual behavior as a result of impaired judgement associated with substance use. The current study evaluated the use of multiple data sources to monitor changes in the rate of cocaine, methamphetamine, and spice related emergency department visits as well as cocaine- and methamphetamine-related death rates, within Marion County, Indiana between 2013 and 2017.

Objective: To assess the prevalence of non-opioid substance use ”including cocaine, methamphetamine and spice within Marion County, Indiana and propose response recommendations utilizing a current opioid response plan.

Although residents of LTCFs have high morbidity and mortality associated with ARIs, there is very limited information on the virology of ARI in LTCFs.[1,2] Moreover, most virological testing of LCTF residents is reactive and is triggered by a resident meeting selected surveillance criteria. We report on incidental findings from a prospective trial of introducing rapid influenza diagnostic testing (RIDT) in ten Wisconsin LTCFs over a two-year period with an approach of testing any resident with ARI.

Objective: To assess the feasibility of conducting respiratory virus surveillance for residents of long term care facilities (LTCF) using simple nasal swab specimens and to describe the virology of acute respiratory infections (ARI) in LCTFs.

Lyme disease (LD), a multisystem infection that is manifested by progressive stages (1), is emerging in central and eastern provinces of Canada due to northward expansion of the geographic range of Ixodes scapularis, the main vector in these regions (2). In 2004, approximately 40 human cases of LD were reported in Canada. In 2009, LD disease became nationally notifiable, with provincial and territorial health departments reporting clinician-diagnosed cases to the Public Health Agency of Canada (PHAC). This study summarizes seven years (2009-2015) of national surveillance data for LD in Canada.

Objective: This study aims to describe incidence over time, geographic and seasonal distribution, demographic and clinical characteristics of Lyme disease cases in Canada.

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 and gaps in the nation'™s environmental health surveillance infrastructure. 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. As a primary objective of the Tracking Program, the Environmental Public Health Tracking Network (Tracking Network) was developed as an online surveillance system with data available for 23 topics and over 450 different health, environmental, and population measures. The integration and display of such disparate data can be challenging. For data consumers without scientific training, or even scientists and public health professionals with limited time, it can be difficult to examine and explore the data in an online surveillance system. Additionally, casual data consumers may not require complex data details; a big picture perspective may be appropriate to their needs. The Tracking Network which applies standardized data, a modern user interface, techniques catering to a variety of data consumers, and best practices in data visualization provides a dynamic data query system that allows users to visualize different types of environmental health data in numerous ways including a variety of charting, mapping, and graphing options. Objective: The presenter will demonstrate complex health and environment surveillance data visualization techniques within the CDC's Environmental Public Health Tracking Network.

Hepatitis C virus (HCV) infection is the most common blood-borne disease in the US and the leading cause of liver-related morbidity and mortality. Approximately 3.5 million individuals in the US were estimated to have been living with hepatitis C in 2010 and approximately half of them were unaware that they were infected. Among HCV infected individuals, those born between 1945 and 1965 (usually referred to as the baby boomer cohort) represents approximately 75% of current cases. Because of the substantial burden of disease among this age group, CDC expanded its existing hepatitis C risk-based testing recommendations to include a one-time HCV antibody test for all persons born between 1945 and 1965. The United States Preventive Services Task Force (USPSTF) subsequently made the same recommendation in June 2013.

Objective: Using a large nationally representative dataset, we estimated the prevalence of self-reported hepatitis C testing among individuals who were recommended to be tested (i.e., baby boomer cohort born between 1945 and 1965) by the CDC and United States Preventive Services Task Force.

Military service members and their families work and live around the world where both endemic and emerging infectious diseases are common. Timely infectious disease surveillance helps to inform medical and policy decisions which ensure mission readiness and beneficiary health. The EpiData Center (EDC) at the Navy and Marine Corps Public Health Center has performed public health surveillance, including routine infectious disease monitoring among service members, their families, and others eligible for military medical benefits for the Department of the Navy (DON) and Department of Defense (DOD) since 2005. The EDC stores and maintains 15 databases totaling over 20 terabytes of health and administrative data. These include administrative data from outpatient encounters and inpatient admissions, Health Level-7 (HL7) formatted ancillary services data, and medical event reports. These data provide the potential for robust surveillance methodologies to monitor diseases of interest and identify trends and outbreaks. The primary intent and design of these data sources is not for disease surveillance, but rather for administrative and billing purposes. However, due to the availability of this data, it is routinely used by academic organizations, private industry, health systems, and government organizations to conduct health surveillance and research. Ancillary services data in particular can be very powerful for near-real time infectious disease surveillance in the DOD as the aggregated data is available within 1 to 2 days after processing. The EDC has demonstrated the value of using laboratory data for surveillance through outbreak detection and longitudinal health trends for specific diseases among select populations. The fact that this data is not designed for surveillance does present several pitfalls in regards to analysis, from issues ranging from free text interpretation to changing testing practices. These pitfalls can be mitigated through standardized processes and detailed quality assurance testing. The EDC has harnessed the power of available administrative health data to improve health outcomes and influence policy among military beneficiaries.

Objective: Discuss the power of utilizing DOD clinical ancillary services data for infectious disease surveillance, the steps used to mitigate pitfalls which may occur during the surveillance process, and the potential of adapting this data for surveillance of emerging infectious diseases.

The opioid overdose crisis has rapidly expanded in North Carolina (NC), paralleling the epidemic across the United States. The number of opioid overdose deaths in NC has increased by nearly 40% each year since 2015.1 Critical to preventing overdose deaths is increasing access to the life-saving drug naloxone, which can reverse overdose symptoms and progression. Over 700 EMS agencies across NC respond to over 1,000,000 calls each year; naloxone administration was documented in over 15,000 calls in 2017.2 Linking EMS encounters with naloxone administration to the corresponding ED visit assists in understanding the health outcomes of these patients. However, less than 66% of NC EMS records with naloxone administration in 2017 were successfully linked to an ED visit record. This study explored methods to improve EMS and ED data linkage, using a multistage process to maximize the number of correctly linked records while avoiding false linkages.

Objective: To improve linkage between North Carolina's Emergency Medical Services (EMS) and Emergency Department (ED) data using an iterative, deterministic approach.

The use of new technologies such as Online Maps and the QR Code facilitates the knowledge dissemination in the health science, aiding in diagnostic elucidation and intelligent decisions making, thus offering an improvement in the quality of care provided to patients. Cases with suspected spotted fever should be approached as potentially serious, which may develop with shock within a few hours and, if not addressed can progress to death. In the case of spotted fever, early onset determines the cure of these cases.

Objective: To perform the spatial distribution of Spotted Fever in the Metropolitan Area of Sao Paulo Municipality (MRSP), coverage area of Epidemiological Surveillance Group VII of Santo Andre (GVE7), to determine clusters of disease incidence, and through QR Code to be able to access data from any smartphone as an aid to the early treatment of new suspected cases.

Anthrax is an acute infectious disease of historical importance caused by Bacillus anthracis (B. anthracis), a spore-forming, soil-borne bacterium with a remarkable ability to persist in the environment. Anthrax is endemic in many countries, including Georgia. Laboratory of the Ministry of Agriculture (LMA) has been actively working on the disease science 1907 and constantly improving diagnostics. In 2009-2017 the laboratory participated in cooperative biological studies. One of the main objectives of these studies was to improve Anthrax laboratory diagnostics in order to properly monitor the prevalence and distribution of the disease in Georgia.

Objective: One of the main objectives of these studies was to improve Anthrax laboratory diagnostics in order to properly monitor the prevalence and distribution of the disease in Georgia. For this geographic information system (GIS) was implemented and used as the additional tool to the laboratory tests for better visualization, summary results and risk assessment.

Hepatitis C virus (HCV) infection is a leading cause of liver disease-related morbidity and mortality in the United States. Approximately 75% of people infected with chronic HCV were born between 1945 and 1965. Since 2012, the CDC has recommended one-time screening for chronic HCV infection for all persons in this birth cohort (baby boomers). The United States Preventive Services Task Force (USPSTF) subsequently made the same recommendation in June 2013. We estimated the rate of HCV testing between 2011 and 2017 among persons with commercial health insurance coverage and compared rates by birth cohort.

Objective: Using the two largest commercial laboratory data sources nationally, we estimated the annual rates of hepatitis C testing among individuals who were recommended to be tested (i.e., baby boomer cohort born between 1945 and 1965) by the CDC and United States Preventive Services Task Force. This panel will discuss strengths and weaknesses for monitoring hepatitis C testing using alternative data sources including self-reported data, insurance claims data, and laboratory testing data.