Surveillance

Legionellosis is a respiratory illness that is mostly (80-90%) caused by the bacterium Legionella pneumophila. It is associated with a mild febrile illness, Pontiac fever, or Legionnaires'™ disease (1), a source of severe, community-acquired pneumonia. Legionella bacteria mostly affect elderly persons specifically those with underlying debilitating illnesses and with lowered immune systems. Water is the major natural reservoir for Legionella, and the pathogen is found in many different natural and artificial aquatic environments such as cooling towers or water systems in buildings, including hospitals. An abrupt increase in the incidence of Legionnaires' has been noted since 2003 throughout the nation. According to CDC, about 6,000 cases of Legionnaires' disease were reported in the United State in 2015 (1). Incidence rates of Legionnaires for the year 2015 were 1.06 and 1.90 (ref) for Texas and the United States respectively (2). Increased number of reported cases might be due to the fact of an older population, more at risk individuals, aging plumbing infrastructure, and increased testing for Legionnaires' disease by various hospitals and laboratories.

Objective: To study trends and patterns in legionnaires' disease cases in Houston, Texas, from 2014-2017.

West Nile virus (WNV) is considered the leading cause of domestically acquired arboviral disease and is spread through mosquitoes. In general, the majority of the cases are asymptomatic. One in five people infected will display mild symptoms like fever, headache, body ache, nausea, and vomiting. Only about 1 in 150 people infected will develop serious neurologic complications such as encephalitis and meningitis. According to CDC, in 2017, there were 133 confirmed cases including 5 deaths and 14 presumptive blood donors reported in the State of Texas. Out of the confirmed cases, there were 85 neuroinvasive and 48 non-neuroinvasive disease cases.

Objective: To demonstrate an overview of the epidemiological and clinical distribution of reportable West Nile cases in Houston, Texas, from 2015-2017.

Chronic diseases, including hypertension, type 2 diabetes mellitus (diabetes), obesity, and hyperlipidemia, are some of the leading causes of morbidity and mortality in the United States. Monitoring disease prevalence guides public health programs and policies that help prevent this burden. EHRs can supplement traditional sources of chronic disease surveillance, such as health surveys and administrative claims datasets, by offering near real-time data, large sample sizes, and a rich source of clinical data. However, few studies have provided clear, consistent EHR phenotypes that were developed to inform population health surveillance.

Objective: To utilize clinical data in Electronic Health Records (EHRs) to develop chronic disease phenotypes appropriate for conducting population health surveillance.

Timely and accurate measurement of overdose morbidity using emergency department (ED) data is necessary to inform an effective public health response given the dynamic nature of opioid overdose epidemic in the United States. However, from jurisdiction to jurisdiction, differing sources and types of ED data vary in their quality and comprehensiveness. Many jurisdictions collect timely emergency department data through syndromic surveillance (SyS) systems, while others may have access to more complete, but slower emergency department discharge datasets. State and local epidemiologists must make decisions regarding which datasets to use and how to best operationalize, interpret, and present overdose morbidity using ED data. These choices may affect the number, timeliness, and accuracy of the cases identified.

Objective: Epidemiologists will understand the differences between syndromic and discharge emergency department data sources, the strengths and limitations of each data source, and how each of these different emergency department data sources can be best applied to inform a public health response to the opioid overdose epidemic.

Health surveillance is well established for infectious diseases, but less so for non-communicable diseases. When spatio-temporal methods are used, selection often appears to be driven by arbitrary criteria, rather than optimal detection capabilities. Our aim is to use a theoretical simulation framework with known spatio-temporal clusters to investigate the sensitivity and specificity of several traditional (e.g. SatScan and Cusum) and Bayesian (incl. BaySTDetect and Dcluster) statistical methods for spatio-temporal cluster detection of non-communicable disease.

Objective: To determine the merits of different surveillance methods for cluster detection, in particular when used in conjuction with small area data. This will be investigated using a simulated framework. This is with a view to support further surviellance work using real small area data.

Cerebral Palsy (CP) is the most common cause of motor disability in children. CP registries often rely on administrative data such as CP diagnoses or International Classification of Diseases (ICD) codes indicative of CP. However, little is known about the validity of these indicators. We calculated sensitivity, specificity, positive and negative predictive values of CP ICD-9 codes and CP diagnoses compared to a gold standard CP classification based on detailed medical and education record review.

Objective: To compare prevalence estimates obtained by the ADDM cerebral palsy surveillance method to other administrative or diagnostic indications of cerebral palsy.

Influenza viral infection is contentious, has a short incubation period, yet preventable if multiple barriers are employed. At some extend school holidays and travel restrictions serve as a socially accepted control measure. A study of a spatiotemporal spread of influenza among school-aged children in Belgium illustrated that changes in mixing patterns are responsible for altering disease seasonality3. Stochastic numerical simulations suggested that weekends and holidays can delay disease seasonal peaks, mitigate the spread of infection, and slow down the epidemic by periodically dampening transmission. While Christmas holidays had the largest impact on transmission, other school breaks may also help in reducing an epidemic size. Contrary to events reducing social mixing, sporting events and mass gatherings facilitate the spread of infections. A study on county-level vital statistics of the US from 1974-2009 showed that Super Bowl social mixing affects influenza dissemination by decreasing mortality rates in older adults in Bowl-participating counties. The effect is most pronounced for highly virulent influenza strains and when the Super Bowl occurs closer to the influenza seasonal peak. Simulation studies exploring how social mixing affects influenza spread demonstrated that impact of the public gathering on prevalence of influenza depends on time proximity to epidemic peak. While the effects of holidays and social events on seasonal influenza have been explored in surveillance time series and agent-based modeling studies, the understanding of the differential effects across age groups is incomplete.

Objective: In the presented study, we examined the impact of school holidays (Autumn, Winter, Summer, and Spring Breaks) and social events (Super Bowl, NBA Finals, World Series, and Black Friday) for five age groups (<4, 5-24, 25-44, 45-64, >65 years) on four health outcomes of influenza (total tested, all influenza positives, positives for influenza A, and B) in Milwaukee, WI, in 2004-2009 using routine surveillance.

Q fever is a zoonotic bacterial disease resulting from infection by Coxiella burnetii. Domestic ruminants (cattle, sheep, and goats) are considered the main reservoir for the pathogen, which can also infect humans. Q fever is poorly understood in Georgia and its prevalence is largely underestimated in both humans and animals. In Georgia Q fever laboratory diagnostic was started and implemented at the Laboratory of the Ministry of Georgia (LMA) within GG20 "Prevalence, Epidemiological Surveillance, and Laboratory Analysis of Coxiella burnetii in Georgia.

Objective: Q fever is poorly understood in Georgia and its prevalence is largely underestimated in both humans and animals. One of the main goal of the project was shedding study in domestic animals isolation of C. burnetii from suspected seropositive animal blood, milk samples.

Drug overdose deaths are increasing nationally and in Minnesota (MN). This is only a fraction of the overall burden that recreational drug use exacts on emergency departments (ED) and hospitals. In addition to opioids and other drugs, three outbreaks of synthetic cannabinoids and cathinones have occurred in MN recently. ICD codes do not adequately identify patients treated for drug use. Also, toxicology data for these patients are limited: routine toxicology testing is not performed at hospitals as results are not timely enough to be useful for clinical care. Even when such testing is performed, hospital laboratories are unable to detect newer synthetic drugs. In order to more quickly respond to clusters of substance use, identify substances causing atypical symptoms or severe illness, and understand the burden of overdoses and substance use in MN, the MN Department of Health (MDH) developed the MN Drug Overdose and Substance Abuse Pilot Surveillance System (MNDOSA). MNDOSA data collection began in November 2017 and includes two pilot sites in Northeastern MN, and one in the Twin Cities Metropolitan Area.

Objective: Implement a novel surveillance system for recreational substance use, including toxicology testing, to enable situational awareness and more accurately assess the health care burden related to recreational substance use.

Bacillus anthracis, the etiologic agent of anthrax, is a member of a highly diverse group of endospore-forming bacteria. Bacillus anthracis spores are typically found in soil, from which they may spread via contaminated dust, water, and materials of plant and animal origin. Although anthrax is primarily a disease of herbivores, humans may contract anthrax directly or indirectly from animals. Laboratory of the Ministry of Agriculture (LMA) conducts Anthrax diagnostics using Bacteriology and Molecular Biology Methods: Isolated cultures through the classical bacteriology methods are always confirmed by Molecular Biology assay (PCR). In 2014, within Tap7 project ,Identification and Mapping of Anthrax foci in Georgia Anthrax suspected soil samples were tested using two lab diagnostic methods and they were compared to each other.

Objective: Laboratory of the Ministry of Agriculture (LMA) conducts Anthrax diagnostics using Bacteriology and Molecular Biology Methods: Isolated cultures through the classical bacteriology methods are always confirmed by Molecular Biology assay (PCR). In the study the samples were screened for the presence of B. anthracis via two concurrent approaches to compare classical methods and a novel PCR method. Before the TAP-7 project, PCR was only used to confirm the identity of cultures isolated by the Bacteriology. New SOPs and algorythm was created for better laboratory diagnostic.