Syndromic Surveillance

A large part of the applied research on syndromic surveillance targets seasonal epidemics, e.g. influenza, winter vomiting disease, rotavirus and RSV, in particular when dealing with preclinical indicators, e.g. web traffic. The research on local outbreak surveillance is more limited. Two studies of teletriage data (NHS Direct) have shown positive and negative results respectively. Studies of OTC pharmacy sales have reported similar equivocal performance. As far as we know, no systematic comparison of data sources with respect to multiple point-source outbreaks has so far been published. In the current study, we evaluated the potential of three data sources for syndromic surveillance by analyzing the correspondence between signal properties and point-source outbreak characteristics.

Objective

For the purpose of developing a national system of outbreak surveillance, we compared local outbreak signals in three sources of syndromic data – telephone triage of acute gastroenteritis (Swedish Health Care Direct 1177), web queries about symptoms of gastrointestinal illness (Stockholm County’s website for healthcare information), and OTC pharmacy sales of anti-diarrhea medication.

The late health events such as the heat wave of 2003 showed the need to make public health surveillance evolve in France. Thus, the French Institute for Public Health Surveillance has developed syndromic surveillance systems based on several information sources such as emergency departments. In Reunion Island, the chikungunya outbreak of 2005-2006, then the influenza pandemic of 2009 contributed to the implementation and the development of this surveillance system. In the past years, this tool allowed to follow and measure the impact of seasonal epidemics. Nevertheless, its usefulness for the detection of minor unusual events had yet to be demonstrated.

Objective

To show with examples that syndromic surveillance system can be a reactive tool for public health surveillance.

The New York State Veterinary Diagnostic Laboratory (NYSVDL) receives more than 100,000 diagnostic submissions a year that are not currently used in any formal syndromic surveillance system. In 2009, a pilot study of syndrome classification schemes was undertaken and in 2011 a new general submission form was adopted, which includes a check list of syndromes, as part of the clinical history.

Monitoring submissions to a veterinary diagnostic laboratory for increases in certain test requests is an established method of syndromic surveillance. The new general submission form allows for clinician selected syndromes to be monitored in addition to test request.

Objective

To assess the use and utility of a syndrome check list on the general submission form of a high volume veterinary diagnostic laboratory, and compare to the results of a 2009 pilot study

The Triple-S project (Syndromic Surveillance Systems in Europe, www.syndromicsurveillance.eu), co-financed by the European Commission and involving twenty four organizations from fourteen countries was launched in September 2010 with the following objectives 1) performing an inventory of existing or planned SyS systems in Europe both in animal and public health, 2) building a network of experts involved in SyS 3) producing guidelines to implement SyS systems, 4) developing synergies between human and animal health SyS systems. The project is based on a cooperation between human and animal health experts, as supported by the One Health initiative [1].

Objective: 

The objective of this study, based on the Triple-S project outputs, was to present the existing synergies between human and animal health syndromic surveillance (SyS) systems in Europe and a proposal to enhance this kind of collaboration.

 

Florida has implemented various surveillance methods to augment existing sources of surveillance data and enhance decision making with timely evidence based assessments to guide response efforts post-hurricanes. Historically, data collected from deployed federal assets have been an integral part of this effort. However, a number of factors have made this type of surveillance challenging: logistical is- sues of field work in a post-disaster environment, the resource inten- sive manual data collection process from DMAT sites, and delayed analysis and interpretation of these data to inform decision makers. The ESSENCE-FL system is an automated and secure web-based ap- plication accessed by FDOH epidemiologists and staff at participat- ing hospitals.

Objective

The Florida Department of Health (FDOH), Bureau of Epidemi- ology, partnered with the U.S. Department of Health and Human Services (HHS) Office of the Assistant Secretary for Preparedness and Response (ASPR) to improve surveillance methods in post dis- aster or response events. A new process was implemented for con- ducting surveillance to monitor injury and illness for those presenting for care to ASPR assets such as Disaster Medical Assistance Team (DMAT) sites when they are operational in the state. The purpose of the current work was to field test and document the operational ex- perience of the newly implemented ASPR data module in ESSENCE- FL (syndromic surveillance system) to receive near real-time automated data feeds when ASPR federal assets were deployed in Florida during the 2012 Republican National Convention (RNC).

MUse will make EHR data increasingly available for public health surveillance. For Stage 2, the Centers for Medicare & Medicaid Services (CMS) regulations will require hospitals and offer an option for eligible professionals to provide electronic syndromic surveillance data to public health. Together, these data can strengthen public health surveillance capabilities and population health outcomes (Figure 1). To facilitate the adoption and effective use of these data to advance population health, public health priorities and system capabilities must shape standards for data exchange. Input from all stakeholders is critical to ensure the feasibility, practicality, and, hence, adoption of any recommendations and data use guidelines.

Objective

To develop national Stage 2 Meaningful Use (MUse) recommendations for syndromic surveillance using hospital inpatient and ambulatory clinical care electronic health record (EHR) data

Lack of access to regular dental care often results in costly, oral health visits to EDs that could otherwise have been prevented or managed by a dentist (1). Most studies on oral health-related visits to EDs have used a wide range of classifications from different databases, but none have used syndromic surveillance data. The volume, frequency, and included details of syndromic data enabled timely burden estimates of nontraumatic oral health visits for NC EDs.

Objective:

To develop a nontraumatic oral health classification that could estimate the burden of oral health-related visits in North Carolina (NC) Emergency Departments (EDs) using syndromic surveillance system data.

 

Los Angeles County’s (LAC) early event detection system captures over 60% of total ED visits, as well as 800 to 1,000 emergency dispatch calls from Los Angeles City Fire (LACF) daily. Both ED visits and EDC calls are classified into syndrome categories, and then analyzed for aberrations in count and spatial distribution. During periods of high temperatures, a heat report is generated and sent to stakeholders upon request. We describe how syndromic surveillance serves as an important near real-time, population-based instrument for measuring the impact of heat waves on emergency service utilization in LAC.

Objective: 

To assess current indicators for situational awareness during heat waves derived from electronic emergency department (ED) and 911 emergency dispatch call (EDC) center data.

 

The incidence of and hospitalizations for SSTI have steadily increased over the last decade in the United States, primarily due to the emergence and spread of community acquired Methicillin resistant Staphylococcus aureus (CA-MRSA). The ED is a common site for SSTI treatment and serves populations not captured by traditional surveillance, including the homeless and uninsured. The use of near real-time syndromic surveillance within the ED to detect unusual activity for further public health investigation has been used to augment traditional infectious disease surveillance. However, the use of this approach for monitoring local epidemiologic trends in SSTI presentation where laboratory data are not available, has not previously been described.

Objective

We sought to describe the epidemiology of emergency department (ED) visits for skin and soft tissue infections (SSTI) in an urban area with diverse neighborhood populations using syndromic surveillance system data for the time period from 2007-2011. Our aims were threefold: to demonstrate a proof of concept using syndromic surveillance for SSTI surveillance in the absence of laboratory data, to estimate the burden of ED visits associated with SSTI, and to determine potential geographic “hotspots” for these infections.