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.
Syndromic Surveillance
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.
In the past, the media has served a source of data for syndromic surveillance of infectious disease, whether it is outbreaks of disease in animals or humans resulting in illness or death. More often than not, the reverse is true; data based on analyses of syndromic surveillance often flows from hospital to local health departments and federal governmental agencies such as the CDC to the media which then relays it to the public. In both instances, the media may serve as a purveyor of vital information. But, sometimes the media reports are less than ideal; the public may become fearful and panic at the news of a potential outbreak of an emerging infectious disease such as bird flu for which there is a high fatality case rate and no proven available vaccine, or curative therapy. Moreover, supplies of vaccine may be limited, and news of a shortage of antiviral medications such as Tamiflu may lead to stockpiling similar to what occurred with Cipro during the anthrax ‘scare.’
Objective:
This paper explores how the mass media covered bird flu outbreaks overseas in the Fall of 2005, and the nationÃs preparations for a possible bird flu pandemic, and how this period of intense media activity affected sales of antivirals in New City and New York State as monitored by syndromic surveillance techniques.
The revised International Health Regulations (IHR) have expanded traditional infectious disease notification to include surveillance diseases of international importance, including emerging infectious diseases. However, there are no clearly established guidelines for how countries should conduct this surveillance, which types of syndromes should be reported, nor any means for enforcement. The commonly established concept of syndromic surveillance in developed regions encompasses the use of pre-diagnostic information in a near real time fashion for further investigation for public health action. Syndromic surveillance is widely used in North America and Europe, and is typically thought of as a highly complex, technology driven automated tool for early detection of outbreaks. Nonetheless, applications of syndromic surveillance using technology appropriate for the setting are being used worldwide to augment traditional surveillance, and may enhance compliance with the revised IHR.
Objective:
To review applications of syndromic surveillance in developing countries
Most research in syndromic surveillance has emphasized early detection, but clinical diagnosis of the index case will tend to occur before detection by syndromic surveillance for certain types of outbreaks [1]. Syndromic surveillance may, however, still play an important role in rapidly characterizing the outbreak size because there will be additional non-diagnosed symptomatic cases in the medical system when the index case is identified. Other authors have shown that the temporal pattern of symptomatic cases could be used to project the total outbreak size, but their approach requires a priori knowledge of the incubation curve for the specific anthrax strain and exposure level [2]. In this paper, we focus on estimating the number of non-diagnosed symptomatic cases at the time of detection without making assumptions about the exposure level or disease course.
Objective
Upon detection of an inhalational anthrax attack, a critical priority for the public health response would be to characterize the size and extent of the outbreak. Our objective is to assess the potential role of syn-dromic surveillance in estimating the outbreak size.
This paper describes a methodology for applying natural language parsing (NLP) technologies, originally developed for analyzing biomedical journal articles, to the monitoring of emergency department patient charts for infectious diseases of interest.
The paper outlined the major findings and statistical results of syndromic surveillance system in Taiwan since year 2000.
Since July 2004 the BioSense program at the Centers for Disease Control and Prevention (CDC) has received data from DoD military and VA outpatient clinics (not in real time). In January 2006 real-time hospital data (e.g. chief complaints and diagnoses) was added. Various diagnoses from all sources are binned into one or more of 11 syndrome categories.
Objective
This paper's objective is to compare syndromic categorization of newly acquired real-time civilian hospital data with existing BioSense data sources.
In order to be best prepared to identify health events using electronic disease surveillance systems, it is vital for users to participate in regular exercises that realistically simulate how events may present in their system following disease manifestation in the community. Furthermore, it is necessary that users exercise methods of communicating unusual occurrences to other intra and extra-jurisdictional investigators quickly and efficiently to determine first, if an event actually exits and if one does its characteristics. A simulation exercise held in the National Capital Region (NCR) in the spring of this year exercised a novel format for engaging users while testing the utility of an embedded event communication tool.
Objective
This is a description of an innovative design and format used to exercise public health preparedness in a tri-jurisdictional disease surveillance system in the spring of 2006.