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Syndromic Surveillance

Syndromic surveillance is used routinely to detect outbreaks of disease earlier than traditional methods due to its ability to automatically acquire data in near real-time. Missouri has used emergency department (ED) visits to monitor and track seasonal influenza activity since 2006.

Objective

To assess how weekly percent of influenza-like illness (ILI) reported via Early Notification of Community-based Epidemics (ESSENCE) tracked weekly counts of laboratory confirmed influenza cases in five influenza seasons in order to evaluate the early warning potential of ILI in ESSENCE and improve ongoing influenza surveillance efforts in Missouri.

Submitted by teresa.hamby@d… on

A decade ago, the primary objective of syndromic surveillance was bioterrorism and outbreak early event detection (EED. Syndromic systems for EED focused on rapid, automated data collection, processing and statistical anomaly detection of indicators of potential bioterrorism or outbreak events. The paradigm presented a clear and testable surveillance objective: the early detection of outbreaks or events of public health concern. Limited success in practice and limited rigorous evaluation, however, led to the conclusion that syndromic surveillance could not reliably or accurately achieve EED objectives. At the federal level, the primary rationale for syndromic surveillance shifted away from bioterrorism EED, and towards allhazards biosurveillance and SA. The shift from EED to SA occurred without a clear evaluation of EED objectives, and without a clear definition of the scope or meaning of SA in practice. Since public health SA has not been clearly defined in terms of operational surveillance objectives, statistical or epidemiological methods, or measurable outcomes and metrics, the use of syndromic surveillance to achieve SA cannot be evaluated.

Objective

Review concept of situation awareness (SA) as it relates to public health surveillance, epidemiology and preparedness. Outline hierarchical levels and organizational criteria for SA. Initiate consensus building process aimed at developing a working definition and measurable outcomes and metrics for SA as they relate to syndromic surveillance practice and evaluation.

Submitted by teresa.hamby@d… on

The homelessness syndrome was developed to identify emergency department visits in ESSENCE for patients who are experiencing homelessness or housing insecurity. The syndrome is intended for use with chief complaint, triage notes, and discharge diagnosis codes (ICD-10 CM). The definition heavily relies on diagnosis codes primarily used by non-critical access hospitals and artificial exclusion of critical access facilities should be considered when data are interpreted.

Submitted by Anonymous on

This query is used to assess trends in hypothermia or cold exposure in emergency department visits in ESSENCE. The query captures cold exposure, hypothermia, and frost bite using chief complaint, triage note, and discharge diagnosis code (ICD-10CM). The query does not exclude hypothermia related to an underlying medical condition.

Submitted by Anonymous on

The attached query was developed to track medication refill encounters in emergency departments in ESSENCE during evacuations or extended mass gathering events. The query was initially developed for use with the chief complaint, triage note, and discharge diagnosis code (ICD-10 CM). 

 

Submitted by Anonymous on

Swimming in contaminated pools can cause gastroenteritis from water contaminated by viruses, bacteria, or parasites. Germs that cause gastroenteritis are shed in feces of infected persons, and easily spread to uninfected persons swimming in pools. Symptoms of gastrointestinal illness can include nausea, vomiting, watery or bloody diarrhea, and weight loss. Common causes of swimming-related gastroenteritis included viruses (norovirus), parasites (giardia, cryptosporidium), and bacteria (Escherichia coli, Shigella). Cryptosporidium is most common agent associated with swimming pool outbreaks. In 2011-2012, public health officials from 32 States reported 90 swimming-pool associated outbreaks to CDC’s Waterborne Disease and Outbreak Surveillance System (WBDOSS). These 90 outbreaks resulted in 1,788 cases, 95 hospitalizations, 1 death. 52% of these outbreaks were caused by Cryptosporidium.

Objective:

To prevent and identify gastrointestinal outbreaks due to swimming pools using a two-part surveillance system i) Model Aquatic Health Code (MAHC) Guideline Survey and ii) syndromic surveillance

Submitted by elamb on

On April 14, 2016, British Columbia (BC)’s Provincial Health Officer declared a public health emergency due to a significant increase in drug-related overdoses and deaths in the Province. Despite the declaration, 161 suspected drug overdose deaths were reported across the Province in December 2016, a 137% increase over the number of deaths occurring in the same month of 2015. In response to the surge overdoses, Vancouver Coastal Health Authority (VCH), one of 5 health regions within BC, rapidly implemented a number of novel harm reduction initiatives. Overdose Prevention Sites (OPS) were opened on December 8, 2016. At these sites, people using illicit drugs are supervised by peers who can provide rapid intervention if an overdose occurs. The Mobile Medical Unit (MMU), a temporary state-of-art medical facility, was deployed on December 13, 2016 to reduce the congestion for the BC Ambulance Service (BCAS) and a major urban emergency department (ED). Following deployment of the MMU, services were transitioned to a permanent program at the Downtown Eastside Connections Clinic (DTES Connections) in the spring of 2017. DTES Connections was created to provide rapid access to addiction treatment. In order to keep pace with the rapidly increasing number of novel harm reduction initiatives, enhanced surveillance programs were implemented at VCH to monitor and evaluate these innovative harm reduction activities, including development of new surveillance programs for the MMU, OPS and DTES Connections, along with existing routine surveillance system from EDs and a Supervised Injection Site (Insite).

Objective:

To describe the use of multiple data sources to monitor overdoses in near real-time in order to evaluate response to the provincial overdose emergency

Submitted by elamb on

Across the U.S.A., multiple people seek treatment for fireworks-related injuries around the July 4th holiday. Syndromic surveillance in Kansas allows for near real-time analysis of the injuries occurring during the firework selling season. During the 2017 July 4th holiday, the Kansas Syndromic Surveillance Program (KSSP) production data feed received data from 88 EDs at excellent quality and timeliness. Previous and current firework safety messaging in Kansas is dependent on voluntary reporting from hospitals across the state. With widespread coverage of EDs by KSSP, data can be more complete and timely to better drive analysis and public information.

Objective:

To develop a syndrome definition and analyze syndromic surveillance data usefulness in surveillance of firework-related emergency department visits in Kansas.

Submitted by elamb on

Syndromic surveillance is commonly supported by information generated from electronic health record (EHR) systems and sent to public health via standardized messaging. Before public health can receive syndromic surveillance information from an EHR, a healthcare provider must demonstrate reliable and timely generation of messages according to national standards. This process is known as onboarding. Onboarding at the Tennessee Department of Health (TDH) focused heavily on human review of HL7 messages. However, the visual inspection of messages was time-intensive and delayed efforts to provide constructive feedback to participating healthcare providers. To ease the quantity of manual review done during the onboarding process, TDH created an application to assist in the process of reviewing syndromic surveillance messages.

Objective:

To show how the creation of a software tool and implementation of new processes improved the efficiency of syndromic surveillance onboarding at the Tennessee Department of Health.

Submitted by elamb on

The Louisiana Office of Public Health (OPH) Infectious Disease Epidemiology Section (IDEpi) conducts syndromic surveillance of Emergency Department (ED) visits through the Louisiana Early Event Detection System (LEEDS) and submits the collected data to ESSENCE. There are currently 86 syndromes defined in LEEDS including infectious disease, injury and environmental exposure syndromes, among others. LEEDS uses chief complaint, admit reason, and/or diagnosis fields to tag visits to relevant syndromes. Visits that do not have information in any of these fields, or do not fit any syndrome definition are tagged to Null syndrome. ESSENCE uses a different algorithm from LEEDS and only looks in chief complaint for symptom information to bin visits to syndromes defined in ESSENCE. Visits that do not fit the defined syndromes or do not contain any symptom information are tagged to Other syndrome. Since the transition from BioSense to ESSENCE, IDEpi has identified various data quality issues and has been working to address them. The NSSP team recently notified IDEpi that a large number of records are binning to Other syndrome, which led to the investigation of the possible underlying data quality issues captured in Other syndrome.

Objective:

This investigation takes a closer look at Other syndrome in ESSENCE and Null syndrome in LEEDS to understand what types of records are not tagged to a syndrome to elucidate data quality issues.

Submitted by elamb on
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