Surveillance

The role of public health in preparing for, responding to, and recovering from emergencies has expanded as a result of the massive impact recent disasters have had on affected populations. Nearly every large-scale disaster carries substantial public health risk and requires a response that addresses immediate effects of the disaster on a population (e.g., mass casualties and severe injuries, lack of shelter in severe weather), as well as subsequent secondary physical effects (e.g., carbon monoxide poisoning due to improper operation or location of carbon monoxide-producing devices such as generators) and emotional effects (e.g., grief, anxiety, and post-traumatic stress disorder) caused by the disaster. Disaster epidemiology has been identified as an evolving field that integrates a variety of data sources and technological and geospatial resources to expedite reporting and to increase the accuracy of information collected and used by emergency planners and incident managers. As the national organization that supports the activities of applied epidemiologists in state, tribal, local, territorial, and federal public health agencies, the Council of State and Territorial Epidemiologists (CSTE) assembled a Disaster Epidemiology Subcommittee of public health experts and practitioners from diverse fields of applied epidemiology to discuss the use of epidemiologic methods in all phases of the disaster management cycle. In 2012, the Subcommittee assessed state-level disaster epidemiology capacity with a focus on surveillance. 

Objective

The panel will discuss the current status of disaster surveillance capabilities at local and state health departments in the United States and will provide an overview of current resources available to epidemiologists for surveillance.

Respiratory infectious diseases are the most common diseases reported in rural China. Studies have suggested that the OTC retail sale data could be used to detect early outbreak (1, 2). However, few researches have performed to identify whether OTC retail sales data could also predict the outbreak in developing countries and resource poor settings. Here, we conducted a web-based syndromic surveillance system with OTC retail sales to detect respiratory epidemics in rural area in China.

Objective

To explore the feasibility of using OTC medication sales data for early detection of respiratory epidemics in rural China.

During responses, an electronic medical record (EMR) allows federal emergency response staff to view and evaluate near real-time clinical encounter data. Analysis of EMR patient data can enhance situational awareness and provide decision advantage for headquarters' staff during both domestic and international events. The EMR was utilized by field medical personnel during the response to the Haiti earthquake.

Objective

To describe some uses of EMR data for surveillance and situational awareness during disaster response.

The Veterans Health Administration (VHA) uses the Electronic Surveillance System for the Early Notification of Community-based Epidemics to detect disease outbreaks and other health-related events earlier than other forms of surveillance. Although Veterans may use any VHA facility in the world, the strongest predictor of which health care facility is accessed is geographic proximity to the patient's residence. A number of outbreaks have occurred in the Veteran population when geographically separate groups convened in a single location for professional or social events. One classic example was the initial Legionnaire's disease outbreak, identified among participants at the Legionnaire's convention in Philadelphia in the late 1970s. Numerous events involving travel by large Veteran (and employee) populations are scheduled each year.

Objective

To develop an algorithm to identify disease outbreaks by detecting aberrantly large proportions of patient residential ZIP codes outside a health care facility catchment area.

Epi-X is an internet-based secure website for the exchange of information regarding developing public health events. Reports are exchanged with state epidemiologists, state health officers, and other key public health officials. Provisional and secure information is regularly posted on Epi-X. The Epi-X user base is restricted to public health officials at the local, state, federal, and international levels. Private health-care practitioners who do not otherwise hold a government position are not given access to Epi-X. As of August 2011, Epi-X has approximately 6,000 users, of which approximately 1,600 are authorized to directly contribute reports regarding developing public health events. Epi-X is frequently used to seek reports of cases of illness related to an outbreak, cluster, or increased occurrence of a specific infectious disease. The usability and usefulness of Epi-X in this capacity has not previously been assessed.

Objective

To evaluate the usability and usefulness of the Epidemic Information Exchange (Epi-X) system, a secure online information exchange provided by the Centers for Disease Control and Prevention (CDC), in assisting with case finding in response to infectious disease outbreaks and clusters that involve, or have the potential to involve, cases in multiple state-level jurisdictions within the United States

Argus is an event-based surveillance system which captures information from publicly available Internet media in multiple languages. The information is contextualized and indications and warning (I&W) of disease are identified. Reports are generated by regional experts and are made available to the system's users. In this study a small-scale disease event, plague emergence, was tracked in a rural setting, despite media suppression and a low availability of epidemiological information.

Objective

To demonstrate how event-based biosurveillance can be utilized to closely monitor disease emergence in an isolated rural area, where medical information and epidemiological data are limited, toward identifying areas for public health intervention improvements.

Cost-effective, flexible and innovative tools that integrate disparate data sets and allow sharing of information between geographically dispersed collaborators are needed to improve public health surveillance practice. Gossamer Health (Good Open Standards System for Aggregating, Monitoring and Electronic Reporting of Health), http://gossamerhealth.org, is an open source system, suitable for server or "cloud" deployment, that is designed for the collection, analysis, interpretation and visualization of syndromic surveillance data and other indicators to monitor population health. The Gossamer Health system combines applied public health informatics research conducted at the University of Washington Center for Public Health Informatics and Washington State Department of Health, in collaboration with other state and local health jurisdictions, the International Society for Disease Surveillance and the Centers for Disease Control and Prevention.

Objective

The goal of this work is to make available to the public health community an open source system that makes available in a standards-based, modular fashion the basic tools required to conduct automated indicator-based population health surveillance. These tools may be deployed in a flexible fashion on health department servers, in the Amazon EC2 cloud, or in any combination, and are coupled through well-defined standards-based interfaces.

The Border Infectious Disease Surveillance (BIDS) program was established in 1999 by the Centers for Disease Control and Prevention and Mexico Secretariat of Health, following mandates from the Council of State and Territorial Epidemiologists and the U.S.-Mexico Border health association to improve border surveillance. The BIDS program is a bi-national public health collaboration to create an active sentinel-site surveillance of infectious disease among the U.S.-Mexico border. It is a collaborative effort between Local, State, Federal, and International Public Health agencies throughout both countries in the border region. This project is aimed at using the best aspects of both countries surveillance system.

Objective

To establish and maintain an active binational sentinel hospital-site surveillance system. To enhance border region epidemiology and laboratory infrastructure.

An expanded ambulatory health record, the Comprehensive Ambulatory Patient Encounter Record (CAPER) will provide multiple types of data for use in DoD ESSENCE. A new type of data not previously available is the Reason for Visit (ROV), a free-text field analogous to the Chief Complaint (CC). Intake personnel ask patients why they have come to the clinic and record their responses. Traditionally, the text should reflect the patient's actual statement. In reality the staff often "translates" the statement and adds jargon. Text parsing maps key words or phrases to specific syndromes. Challenges exist given the vagaries of the English language and local idiomatic usage. Still, CC analysis by text parsing has been successful in civilian settings [1]. However, it was necessary to modify the parsing to reflect the characteristics of CAPER data and of the covered population. For example, consider the Shock/Coma syndrome. Loss of consciousness is relatively common in military settings due to prolonged standing, exertion in hot weather with dehydration, etc., whereas the main concern is shock/coma due to infectious causes. To reduce false positive mappings the parser now excludes terms such as syncope, fainting, electric shock, road march, parade formation, immunization, blood draw, diabetes, hypoglycemic, etc.

Objective

Rather than rely on diagnostic codes as the core data source for alert detection, this project sought to develop a Chief Complaint (CC) text parser to use in the U.S. Department of Defense (DoD) version of the Electronic Surveillance System for Early Notification of Community-Based Epidemics (ESSENCE), thereby providing an alternate evidence source. A secondary objective was to compare the diagnostic and CC data sources for complementarity.

People usually celebrate holidays by inviting family and friends to have food at home, or by gathering and eating at restaurants or in other public venues. This increased exposure to food with a common source can create conditions for outbreaks of gastrointestinal illnesses. Holidays can also be targeted by bioterrorists who seek to maximize physical damage, psychological impact, and publicity around dates of patriotic or religious significance. They might aim at contaminating food and water supplies, especially with CDC-defined category B agents that can cause diseases such as salmonellosis, shigellosis, cholera, crytosporidiosis, as well as infections with Escherichia coli O157:H7 and the Epsilon toxin of Clostridium perfringens. Hence, there is a need to quantify whether gastrointestinal illnesses increase around holidays. This can also help determine a baseline of the incidence to which future holiday periods should be compared to. This research does not focus on specific reportable diseases. That will be the purpose of forthcoming research. Instead, ED visits with gastrointestinal symptoms are used to leverage the capability of syndromic surveillance for early detection.

Objective

To quantify Emergency Department (ED) visits with gastrointestinal symptoms during Federal holidays in Miami-Dade.