Syndromic Surveillance

The objectives of the two day International Society for Disease Surveillance (ISDS) funded consultation were to develop expert, consensus-based recommendations that address specific, unanswered questions that hinder advances in cross border syndromic surveillance. The consultation included a discussion of the details of existing Canadian (Can) and United States (US) syndromic surveillance systems and the opportunities and challenges for new developments. Particular focus was placed on the ability to detect and respond to a bioterrorism event or infectious disease outbreak across borders.

This panel member consultation is an International Society of Disease Surveillance (ISDS) sponsored project. It involved expert personnel in their respective area to address specific, priority questions confronting researchers, developers, and public health practioners in the field of syndromic surveillance (SS). The objective of this consultation will be to develop expert, consensus-based recommendations that address specific, unsettled problems or unanswered questions that hinder advances in utilization of syndromic surveillance data in combination with other data sources. Recommendations arising from the consultation should facilitate efforts by researchers, developers, or practitioners to be able to stride ahead and make progress.

This paper describes a study of various aberration detection algorithms currently used in syndromic surveillance and one based on artificial neural networks developed at Guelph. The goal of the research is not to select one ìwinningî algorithm but to instead understand the characteristics of the algorithms so that a systems designer can successfully use all of these algorithms in an outbreak detection system.

This paper will use CDCís EARS-X to examine Tele-healthís potential as an early warning system specifically for influenza-like illness compared to NACRS, as well as qualitatively comparing the resultant EARS flags to peaks in influenza activity identified by the Public Health Agency of Canadaís (PHAC) Federal Influenza surveillance system (Fluwatch).

The objective of this paper is to examine the utility of Emergency Department and Telehealth data for Syndromic Surveillance. This works attempts to minimize false outbreak detection. It also demonstrates that these two data sources contain independent information which is useful for outbreak detection.

This paper evaluates the operating characteristics of limited baseline aberration detection methods using different lengths (7-28 days) and end dates (1-7 days prior to the current day) for the baseline period using simulated outbreaks added to real data and simulated data representative of real data.

To measure the impact, within administrative geographic areas, of household income on rates of visits due influenza and RSV among children using real-time syndromic surveillance.

The objectives of this consultation, supported by the International Society for Disease Surveillance (ISDS), were to develop expert, consensus-based recommendations to promote Canadian and U.S. collaboration in using syndromic surveillance (SS) to detect, assess, monitor, or respond to potential or actual public health threats. The consultation focused on the Great Lakes region of the Canadian-U.S. borderóa region where there is substantial flow of people and goods between the two nations, a potential for occurrence of public health emergencies that affect people in both countries. Despite prior advances achieved by participants in the Early Warning Infectious Disease Surveillance (EWIDS) program regarding cross-border collaboration in notifiable disease reporting and follow-up, the EWIDS deliberations had not substantially addressed the role and uses of syndromic surveillance as part of cross-border disease prevention and control efforts, particularly in the context of potential large-scale public health emergencies. Presentations addressed a mix of issues that define the context for cross- border collaboration, including updates on SS practice and development in jurisdictions in the region, shared methodological challenges, protocols for responding to SS alerts, health information privacy regulations, and policies concerning public health emergencies that may shape information sharing during a crisis. Potential legal barriers to information sharing centered on individual-level privacy concerns, as opposed to sharing of aggregate SS data or notices of statistical alerts based on SS data. The meeting provided an impetus and agenda for future, ongoing consideration of including syndromic surveillance as a key component within the broader context of the EWIDS process. Identified priorities included development of procedures to share information about SS alerts and alert response protocols within EWIDS, increased use of SS inputs in crossborder tabletop exercises for pandemic influenza, and further collaboration in development of mapping projects that use data inputs from both sides of the border. In addition, the participants recommended that annual ISDS conferences provide a forum to address challenges in cross-border collaboration in SS practice and research.

Influenza epidemics occur seasonally, impose a high economic burden on the health care system, and are responsible for substantial morbidity and mortality (1). The past century has seen three influenza A pandemics with variable severity. The recent outbreaks of avian influenza involving different virus strains in Asia, North America and the Netherlands, indicates the increasing potential of a new influenza pandemic (2). Public and political awareness needs to be strengthened while public health surveillance strategies need significant improvements if we are to mitigate such a potentially devastating worldwide pandemic, and provide the healthcare system with as much early warning as possible to enhance preparedness. Telehealth Ontario is a provincial telephone helpline for health information staffed by nurses that, if monitored on a real-time basis, has the potential to identify increases in seasonal respiratory infection rates. A recent study suggested that Telehealth Ontario respiratory calls reflect the seasonality of diagnosed respiratory illnesses in emergency departments (van Dijk et al., unpublished data), but an estimation of how respiratory pathogens contribute to Telehealth Ontario’s respiratory complaint calls has not been studied.

Objective:

This paper will explore the possibility and utility of monitoring Telehealth Ontario respiratory calls as an efficient public health influenza strategy for early warning by comparing this data source to provincial viral lab data.

 Syndromic surveillance systems often classify patients into syndromic categories based on emergency department (ED) chief complaints. There exists no standard set of syndromes for syndromic surveillance, and the available syndromic case definitions demonstrate substantial heterogeneity of findings constituting the definition. The use of fever in the definition of syndromic categories is arbitrary and unsystematic. We determined whether chief complaints accurately represent whether a patient has any of five febrile syndromes: febrile respiratory, febrile gastrointestinal, febrile rash, febrile neurological, or febrile hemorrhagic.