Why the syndrome was created:
The purpose of the CDC Legionella v1 ESSENCE query is to capture potential visits related to Legionella. It is useful to identify potential cases for follow-up, conduct situation awareness and monitoring of outbreaks, and perform retrospective trend monitoring across geographic regions to identify possible disease hotspots, etc.
Data sources the syndrome was used on (e.g., emergency room, EMS, air quality):
Emergency room
A comprehensive electronic medical record (EMR) represents a rich source of information that can be harnessed for epidemic surveillance. At this time, however, we do not know how EMR-based data elements should be combined to improve the performance of surveillance systems. In a manual EMR review of over 15 000 outpatient encounters, we observed that two-thirds of the cases with an acute respiratory infection (ARI) were seen in the emergency room or other urgent care areas, but that these areas received only 15% of total outpatient visits. Because of this seemingly favorable signal-to-noise ratio, we hypothesized that an ARI surveillance system that focused on urgent visits would outperform one that monitored all outpatient visits.
Previous reports have demonstrated the media’s influence on ED visits in situations such as dramatized acetaminophen overdose, media report of celebrity suicides, television public announcements for early stroke care and cardiac visits following President Clinton’s heart surgery. No previous study has demonstrated the influence of media-publicized trauma on ED visits. On 16 March 2009, the actress Natasha Richardson suffered a traumatic brain injury leading to her death on 18 March; these events were widely publicized by national news sources. The health departments of New York City, Boston, Duval County and Seattle monitor ED visits daily, and capture 95, 100, 100 and 95% of all ED visits, respectively. The data collected include basic demographic information, chief complaint and in some cases ICD-9 diagnosis codes.
Objective
This study describes an increase in head trauma-related visits to emergency departments (ED) in New York City, New York; Boston, Massachusetts; Duval County, Florida; and Seattle, Washington following the widespread media coverage of actress Natasha Richardson’s head injury and subsequent fatal epidural hematoma.
Group A Streptococcal (GAS) pharyngitis, the most common bacterial cause of acute pharyngitis, causes more than half a billion cases annually worldwide. Treatment with antibiotics provides symptomatic benefit and reduces complications, missed work days and transmission. Physical examination alone is an unreliable way to distinguish GAS from other causes of pharyngitis, so the 4-point Centor score, based on history and physical, is used to classify GAS risk. Still, patients with pharyngitis are often misclassified, leading to inappropriate antibiotic treatment of those with viral disease and to under-treatment of those with bone fide GAS. One key problem, even when clinical guidelines are followed, is that diagnostic accuracy for GAS pharyngitis is affected by earlier probability of disease, which in turn is related to exposure. Point-of-care clinicians rarely have access to valuable biosurveillance-derived contextualizing information when making clinical management decisions.
Objective
The objective of this study was to measure the value of integrating real-time contemporaneous local disease incidence (biosurveillance) data with a clinical score, to more accurately identify patients with Group A Streptococcal (GAS) pharyngitis.
The EPA Water Security initiative contamination warning system (CWS) detection strategy involves the use of multiple monitoring and surveillance components for timely detection of drinking water contamination in the distribution system. The public health surveillance (PHS) component of the contamination warning system involves the analysis of health-related data to identify disease events that may stem from drinking water contamination. Public health data include hospital admission reports, infectious disease surveillance, emergency medical service reports, 911 calls and poison control center (PCC) calls. Automated analysis of these data streams results in alerts, which are investigated by health department epidemiologists. A comprehensive operational strategy was developed to describe the processes and procedures involved in the the initial investigation and validation of a PHS alert. The operational strategy established specific roles and responsibilities, and detailed procedural flow descriptions. The procedural flow concluded with the determination of whether or not an alert generated from surveillance of public health data streams is indicative of a possible water contamination incident.
Objective
To develop standard operating procedures (SOPs) to identify or rule out possible water contamination as a cause for a syndromic surveillance alarm.
Prior work demonstrates the extent to which sampling strategies reduce the power to detect clusters.1 Additionally, the power to detect clusters can vary across space.2 A third, unexplored, effect is how much the sample size impacts the power of spatial cluster detection methods. This research examines this effect.
Objective
In syndromic surveillance settings, the use of samples may be unavoidable, as when only a part of the population reports flu-like symptoms to their physician. Taking samples from a complete population weakens the power of spatial cluster detection methods.1 This research examines the effectiveness of different sampling strategies and sample sizes on the power of cluster detection methods.
On September 10, 2017, Hurricane Irma made landfall in Florida. Over 90% of Florida counties reported power outages as of September 11. During power outages, CO poisonings often occur due to indoor use of fuel combustion sources (e.g., cooking, heating) or generators for electricity. CO poisoning is a reportable condition in Florida; health care providers and laboratories are required to report suspected cases to the Florida Department of Health (FDOH). In Florida, approximately 202 cases of CO poisoning are reported each year (three-year average from 2014 to 2016). In addition to passive surveillance, FDOH uses the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE-FL) to find cases of CO poisoning. ESSENCE-FL provides access to ED data from 98% (255 out of 260) of EDs in Florida and all statewide FPICN call data (includes three poison control centers). ESSENCE-FL provides near real-time access to these data sets, as ED data are uploaded every 2 hours or once a day (depending on the hospital system) and FPICN data are uploaded every 10 minutes. The statewide FPICN database includes information about substance, signs and symptoms, exposure scenario, and patient identification information provided by the individual caller or clinician from a health care facility.
Objective: This study describes how Florida Poison Information Center Network (FPICN) and emergency department (ED) data accessed through Florida's syndromic surveillance system were used to conduct near real-time carbon monoxide (CO) poisoning surveillance and active case finding in response to Hurricane Irma in Florida..
West Virginia continues to lead the nation in drug overdose deaths per capita. In 2016, the age-adjusted rate of drug overdose deaths was 52 per 100,0001. In the same year, there were roughly 64,000 overdose deaths in the United States, a 21.5% rate increase from 20151. The drug overdose epidemic in West Virginia has taken a significant toll on individuals, families, communities, and resources. As part of a rapid response plan to help reduce the burden of overdose deaths, the West Virginia Department of Health and Human Resources conducted an investigative report to study 830 overdose related deaths that occurred in 2016 and identify opportunities for intervention in the 12 months prior to death. Utilization of EMS among decedents was analyzed to determine demographic differences between decedents at different time points of EMS contact: EMS contact at death only; EMS contact 12 months prior to death only; and both EMS contact at death and 12 months prior to death.
Objective: Opioid and illicit substance abuse continues to have major public health implications in the state of West Virginia. By analyzing the Emergency Medical Service (EMS) utilization history of drug overdose decedents, opportunities to improve surveillance of fatal and non-fatal drug overdoses can be identified which can help lead prevention efforts of fatal drug overdoses in the state.
In March 2018, the Illinois Department of Public Health (IDPH) was informed of a cluster of coagulopathy cases linked to SC use. By June 30, 2018, 172 cases were reported, including five deaths, where 74% were male and the mean age was 35.3 years (range: 18âÂÂ65 years). All cases presented to an emergency department (ED) at least once for this illness. Ninety-four cases provided clinical specimens and all tested positive for brodifacoum, a long-acting anticoagulant used in rodenticide. Cases were reported to the health department by the Illinois Poison Control Center and direct reporting from hospitals. REDCap was the primary database for tracking cases and collecting demographic information, risk factor data and healthcare facility utilization, including number of ED visits. Syndromic surveillance was utilized to monitor ED visits related to the cluster, assist with case finding and provide situational awareness of the burden on the EDs and geographic spread. In this study, we retrospectively used syndromic surveillance along with the data in REDCap to quantify the number of ED visits per coagulopathy case, understand the reasons for repeat visits, and determine whether visits were captured in syndromic surveillance.
Objective: To determine whether emergency department (ED) visits were captured in syndromic surveillance for coagulopathy cases associated with an outbreak linked to synthetic cannabinoid (SC) use and to quantify the number of ED visits and reasons for repeat visits.
This study uses data from the New Jersey syndromic surveillance system (EpiCenter) as a data source to enhance surveillance of current non-fatal occupational injuries, illnesses, and poisonings. EpiCenter was originally developed for early detection and monitoring of the health of communities using chief complaints from people seeking acute care in hospital emergency rooms to identify health trends. Currently, syndromic surveillance has not been widely applied to identify occupational injuries and illnesses. Incorporating syndromic surveillance data from EpiCenter, along with hospital discharge data, will enhance the classification and capture of work-related non-fatal injuries with possible improved efforts at prevention.
Objective: To evaluate the use of a real-time surveillance tool to track a variety of occupationally-related emergency room visits through the state based syndromic surveillance system, EpiCenter.