Surveillance

In 2013, the Utah Department of Health (UDOH) began working with hospital and reference laboratories to implement electronic laboratory reporting (ELR) of reportable communicable disease data. Laboratories utilize HL7 message structure and standard terminologies such as LOINC and SNOMED to send data to UDOH. These messages must be evaluated for validity, translated, and entered into Utah’s communicable disease surveillance system (UT-NEDSS), where they can be accessed by local and state investigators and epidemiologists. Despite the development and use of standardized terminologies, reporters may use different, outdated versions of these terminologies, may not use the appropriate codes, or may send local, home-grown terminologies. These variations cause problems when trying to interpret test results and automate data processing. UDOH has developed a two-step translation process that allows us to first standardize and clean incoming messages, and then translate them for consumption by UT-NEDSS. These processes allow us to efficiently manage several different terminologies and helps to standardize incoming data, maintain data quality, and streamline the data entry process.

Objective:

The objective of this abstract is to illustrate how the Utah Department of Health processes a high volume of electronic data. We do this by translating what reporters send within an HL7 message into "epidemiologist" language for consumption into our disease surveillance system.

The mortality monitoring system (initiated in 2009 during the influenza A(H1N1) pandemic) is a collaboration between the Centre for Infectious Disease Control (CIb) of National Institute for Public Health and the Environment (RIVM) and Statistics Netherlands. The system monitors nation-wide reported number of deaths (population size 2017: 17 million) from all causes, as cause of death information is not available real-time. Data is received from Statistics Netherlands by weekly emails.

Objective:

Weekly numbers of deaths are monitored to increase the capacity to deal with both expected and unusual (disease) events such as pandemic influenza, other infections and non-infectious incidents. The monitoring information can potentially be used to detect, track and estimate the impact of an outbreak or incident on all-cause mortality.

The National Surveillance Team in the Enteric Diseases Epidemiology Branch of the Centers for Disease Control and Prevention (CDC) collects electronic data from all state and regional public health laboratories on human infections caused by Campylobacter, Salmonella, Shiga toxin-producing E. coli, and Shigella in LEDS. These data inform annual estimates of the burden of illness, assessments of patterns in bacterial subtypes, and can be used to describe trends in incidence. Robust digital infrastructure is required to process, validate, and summarize data on approximately 60,000 infections annually while optimizing use of financial and personnel resources.

Objective:

The œledsmanageR, a data management platform built in R, aims to improve the timeliness and accuracy of national foodborne surveillance data submitted to the Laboratory-based Enteric Disease Surveillance (LEDS) system by automating the data processing, validating, and reporting workflow.

Pneumonia, an infection of the lung due to bacterial, viral or fungal pathogens, is a significant cause of morbidity and mortality worldwide. In the past few decades, the threat of emerging pathogens presenting as pneumonia, such as Severe Acute Respiratory Syndrome, avian influenza A(H5N1) and A(H7N9), and Middle East Respiratory Syndrome coronavirus has emphasised the importance of the surveillance of pneumonia and other severe respiratory infections. An unexpected increase in the number of hospital admissions for pneumonia or severe respiratory infections could be a signal of a change in the virulence of the influenza viruses or other respiratory pathogens circulating in the community, or an alert of an emerging pathogen which warrants further public health investigation. The purpose of this study was to develop a forecasting model to prospectively forecast the number of emergency department (ED) admissions due to pneumonia in Singapore, a tropical country. We hypothesise that there is complementary information between hospital-based and community-based surveillance systems. The clinical spectrum of many respiratory pathogens causing pneumonia ranges from asymptomatic or subclinical infection to severe or fatal pneumonia, and it is usually difficult to distinguish between the different pathogens in the absence of a laboratory test. Infected persons could present with varying degrees of severity of the infection, and seek treatment at different healthcare facilities. Hospital-based surveillance captures the more severe manifestation of the infection while community-based surveillance captures the less severe manifestation of the infection and enables earlier detection of the infection. Thus, the integration of information from the two surveillance systems should improve the prospective forecasting of ED admissions due to pneumonia. We also investigate if the inclusion of influenza data from the laboratory surveillance system would improve the forecasting model, since influenza circulates all-year round in Singapore and is a common aetiology for pneumonia.

Objective:

To develop a forecasting model for weekly emergency department admissions due to pneumonia using information from hospital-based, community-based and laboratory-based surveillance systems.

Antimicrobial resistance (AMR) is a major concern in developing countries. Uganda is one of many developing countries that are beginning to implement a surveillance program countrywide to monitor AMR within the animal, environmental, and human sectors. Not only is there a concern for AMR, but the emergence of multidrug resistance (MDR) of Salmonella is also becoming a major One Health problem. Few new drugs are being produced. When current treatments fail, new antimicrobials for treatment of these microorganisms are limited. In Salmonella, AMR genes are usually found on plasmids that are transferable. Most plasmids that carry resistance are conjugative plasmids, promoting the transfer of DNA from cell to cell. Class I Integrons are located on transposable plasmids and are known to transfer AMR through an assortment of gene cassettes. Extended-spectrum β-lactamases (ESBLs) are also known to encode genes located on integrons and transposons. ESBLs confer resistance to third generation cephalosporins, a drug of choice for treatment of Salmonella infections. ESBLs are now reported in Enterobacteriaceae all over the world. Examples of common ESBLs include blaCTX-M, blaOXA, blaTEM, blaCMY, and blaSHV. It has been reported that ESBLs evolved from the Kluverya species chromosome by mutation and gene transposition. In our previous study, we phenotypically characterized Salmonella from cattle and poultry farms within the Wakiso District of Uganda. Based on the high prevalence of MDR in the isolates collected we continued investigating at the molecular level. For the Salmonella isolates, we wanted to characterize genotypes by first analyzing the relatedness of the isolates with pulse field gel electrophoresis (PFGE). Next, we wanted to look to see which DNA plasmids were present. We looked at 28 replicon plasmids and the Class 1 Integron, Int1. The Salmonella isolates were also screened for ESBL genes based on their resistant profiles.

Objective:

Determine the AMR phenotypes and genotypes of Salmonella isolates recovered from cattle and poultry farms in the Wakiso District of Uganda.

Violence-related injuries are a major source of morbidity and mortality in NC. From 2005-2014, suicide and homicide ranked as NC's 11th and 16th causes of death, respectively. In 2014, there were 1,932 total violent deaths, of which 1,303 were due to suicide (67%), 536 due to homicide (28%), and 93 due to another mechanism of violent injury (5%). These deaths represent a fraction of the total number of violence-related injuries in NC.1 This study examined ED visit data captured by NC DETECT to identify and describe violent injuries treated in NC EDs and compare/contrast with fatalities reported by NC-VDRS.

Objective:

To describe violent injuries treated in North Carolina (NC) emergency departments (EDs) and compare to deaths reported by the NC Violent Death Reporting System (NC-VDRS).

Harmful algal blooms (HABs) consist of colonies of prokaryotic photosynthetic bacteria algae that can produce harmful toxins. The toxins produced by HABs are considered a One Health issue. HABs can occur in all types of water (fresh, brackish, and salt water) and are composed of cyanobacteria or microalgae. As the climate changes, so do many of the factors that contribute to the growth of HABs, which in turn, can increase the incidence of HAB-related illness in humans. There are three main pathways that HAB toxins can affect human health: dermal, gastrointestinal (GI), and neurological. Swimming in or consuming contaminated water and eating contaminated shellfish are ways to develop HAB-related illnesses. Contact with cells from a bloom while recreating can cause a rash on the body. Most commonly, HAB-related illnesses present with GI symptoms that resemble food poisoning and can affect the liver. Rarely, HABs that produce cyanotoxins can present with neurological symptoms. Issuing and lifting freshwater HAB advisories is within the preview of the Environmental Public Health section at the Oregon Public Health Division. However, most water bodies in the state are not monitored. Because of this, syndromic surveillance was considered as a potentially useful source of HAB exposure information, and the Oregon ESSENCE team was asked to develop a query to help monitor HAB-related complaints.

Objective:

Use ESSENCE to create a sustainable process for identifying ED and urgent care visits that may be related to harmful algal bloom exposure in Oregon.

Timely identification of arboviral disease is key to prevent transmission in the community, but traditional surveillance may take up to 14 days between specimen collection and health department notification. Arizona state and county health agencies began monitoring National Syndromic Surveillance Program BioSense 2.0 data for patients infected with West Nile virus (WNV), St. Louis encephalitis virus (SLEV), chikungunya, or dengue virus in August 2015. Zika virus was added in April 2016. Our novel methods were presented at the International Society for Disease Surveillance 2015 Annual Conference. Twice per week, we queried patient records from 15 Maricopa County BioSense-enrolled emergency department and inpatient hospitals for chief complaint keywords and discharge diagnosis codes. Our Case Investigation Decision Tree helped us determine whether records had a high or low degree of evidence for arboviral disease and necessitated further investigation. This study evaluated how Arizona’s protocol for conducting syndromic surveillance compared to traditional arboviral surveillance in terms of accuracy and timeliness in Maricopa County from August 2015 through December 2016.

Objective:

To evaluate Arizona’s arboviral syndromic surveillance protocol in Maricopa County.

Pesticide-related illness and injury is a reportable condition in Florida. In August and September 2016, aerial spraying for mosquito control was conducted in an effort to reduce the population of Aedes aegypti mosquitoes in Miami-Dade County.1 Two areas Wynwood (in August) and Miami Beach (in September) were sprayed with naled. Naled is an organophosphate insecticide registered with the U.S. Environmental Protection Agency (EPA) which is applied via aerial ultra-low volume (ULV) spraying. In addition to routine surveillance using FPICN and reportable disease surveillance data to identify acute naled-related illness, the Florida Department of Health (DOH) also monitored ED chief complaints data to identify any associated increase in ED visits.

Objective:

To describe the use of Florida Poison Information Center Network (FPICN) and Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE-FL) emergency department (ED) chief complaints data to identify acute naled-related illness following aerial spraying in Miami-Dade county, Florida in response to the Zika outbreak.