Syndromic Surveillance

The August 21, 2017 total solar eclipse in Idaho was anticipated to lead to a large influx of visitors in many communities, prompting a widespread effort to assure Idaho was prepared. To support these efforts, the Idaho Syndromic Surveillance program (ISSp) developed a plan to enhance situation awareness during the event by conducting syndromic surveillance using emergency department (ED) visit data contributed to the National Syndromic Surveillance Program’s BioSense platform by Idaho hospitals. ISSp sought input on anticipated threats from state and local emergency management and public health partners, and selected 8 syndromes for surveillance. Ideally, the first electronic message containing information on an emergency department visit is sent to ISSp within 24 hours of the visit and includes the chief complaint for the visit. Data on other variables, such as diagnosis codes, are updated by subsequent messages for several days after the visit. Chief complaint (CC) text and discharge diagnosis (DD) codes are the primary variables used for syndrome match; delay in reporting these variables adversely affects timely syndrome match of visits. Because our plan included development of new syndrome definitions and querying data within 24 hours of visits, earlier than ISSp had done previously for trend analysis, we sought to better understand syndrome performance.

Objective:

In August 2017, a large influx of visitors was expected to view the total solar eclipse in Idaho. The Idaho Syndromic Surveillance program planned to enhance situation awareness during the event. In preparation, we sought to examine syndrome performance of several newly developed chief complaint and combination chief complaint and diagnosis code syndrome definitions to aid in interpretation of syndromic surveillance data during the event.

ILINet is a CDC program that has been used for years for influenza-like illness (ILI) surveillance, using a network of outpatient providers who volunteer to track and report weekly the number of visits due to ILI and the total number of visits to their practice. Pennsylvania has a network of 95 providers and urgent care clinics that submit data to ILINet. However, ongoing challenges in recruiting and retaining providers, and inconsistent weekly reporting are barriers to receiving accurate, representative, and timely ILI surveillance data year-round. Syndromic surveillance data have been used to enhance outpatient ILI surveillance in a number of jurisdictions, including Pennsylvania. At present, 156 hospitals, or 90% of all Pennsylvania hospitals with emergency departments (EDs), send chief complaint and other information on their ED visits to the Department of Health’s (PADOH) syndromic surveillance system. PADOH evaluated the consistency and reliability of ILI syndromic data as compared to ILINet data, to confirm that syndromic data were suitable for use in ILINet.

Objective:

Discuss use of syndromic surveillance as a source for the state’s ILI/Influenza surveillance Discuss reliability of syndromic data and methods to address problems caused by data outliers and inconsistencies.

Final Four-associated events culminated in four days of intense activity from 3/31/17-4/3/17, which attracted an estimated 400,000 visitors to Maricopa County (population 4.2 million). Field teams of staff and volunteers were deployed to three days of Music Fest, four days of Fan Fest, and three Final Four games (Games) as part of an enhanced epidemiologic surveillance system.

Objective:

To describe and present results of field-based near-real time syndromic surveillance conducted at first aid stations during the 2017 National Collegiate Athletic Association Division I Men’s College Basketball Championship (Final Four) events, and the use of field team data to improve situational awareness for Mass Gathering events.

Panchkroshi yatra is an annual ritual of circumambulation (yatra) of temples (Mahadevs) and 100,000 devotees walk for around 15 miles per day for six days and cover a total of 73 miles to worship important Mahadevs. The festival is held every year at the city of Ujjain, Madhya Pradesh, Central India. The yatra attracts large number of pilgrims especially from rural areas and usually women outnumber men. During the yatra, the pilgrims halt at several places and prepare their food in outdoors. We described the public health preparedness, implemented a tablet-based participatory syndromic surveillance among pilgrims of the yatra and reviewed satisfaction of the pilgrims regarding implementation of public health measures, Ujjain during 21-26, April, 2017.

Objective:

To study operation feasibility and prepadness of a a tablet-based participatory syndromic surveillance among pilgrims during annual ritual circumbulation (Panchkroshi Yatra) coveirng 15 miles daily in Ujjain, Madhya Pradesh India

Early Notification Detection Systems have taken a critical role in providing early notice of disease outbreaks. To improve the detection methods for disease outbreaks, many detection methods have been created and implemented. However, there is limited information on the effectively of syndromic surveillance in Thailand. Knowing the performance, strengths and weakness of these surveillance systems in providing early warning for outbreaks will increase disease outbreak detection capacity in Thailand.

Objective:

This paper presents an investigation using early notification methods to enhancing epidemic detection in syndromic surveillance data from royal Thai army in Thailand.

The use of social media as a syndromic sentinel for diseases is an emerging field of growing relevance as the public begins to share more online, particularly in the area of influenza. Several applications have been developed to predict or monitor influenza activity using publicly posted or self-reported online data; however, few have prioritized accuracy at the local level. In 2016, the Cook County Department of Public Health (CCDPH) collected localized Twitter information to evaluate its utility as a potential influenza sentinel data source. Tweets from MMWR week 40 through MMWR week 20 indicating influenza-like illness (ILI) in our jurisdiction were collected and analyzed for correlation with traditional surveillance indicators. Social media has the potential to join other sentinels, such as emergency room and outpatient provider data, to create a more accurate and complete picture of influenza in Cook County.

Objective:

To determine if social media data can be used as a surveillance tool for influenza at the local level.

In 2005, the Cook County Department of Public Health (CCDPH) began using the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE) as an emergency department (ED)-based local syndromic surveillance program (LSSP); 23 (100%) of 23 hospitals in suburban Cook County report to the LSSP. Data are transmitted in delimited ASCII text files (i.e., flat files) and contain a unique patient identifier, visit date and time, zip code, age, sex, and chief complaint. Discharge diagnosis and disposition are optional data elements. Prior to 2017, the Illinois Department of Public Health placed facilities participating in the Cook LSSP in a holding queue to transform their flat file submissions into a HL7 compliant message; however as of 2017, eligible hospitals must submit HL7 formatted production data to IDPH to fulfill Meaningful Use. The primary syndromic surveillance system for Illinois is the National Syndromic Surveillance Program (NSSP), which transitioned to an ESSENCE interface in 2016. As of December 2016, 20 (87%) of 23 hospitals reporting to the LSSP also reported to IDPH and the NSSP. As both syndromic surveillance systems aim to collect the same data, and now can be analyzed with the same interface, CCDPH sought to compare the LSSP and NSSP for data completeness, consistency, and other attributes.

Objective:

This analysis was undertaken to determine how the data completeness, consistency, and other attributes of our local syndromic surveillance program compared to the National Syndromic Surveillance Platform.

Final Four-associated events culminated in four days of intense activity from March 31st through April 3rd, and added an estimated 400,000 visitors to Maricopa County's 4.2 million residents.

Objective:

To describe and present results for the enhanced epidemiologic surveillance system established during the 2017 National Collegiate Athletic Association Division I Men’s College Basketball Championship (Final Four) events.

Tobacco use is the leading global cause of preventable death, killing more than five million people per year. In addition, exposure to secondhand smoke is estimated to kill an additional 600,000 people globally each year. In 1986, the US Surgeon General’s Report declared secondhand smoke to be a cause of lung cancer in healthy nonsmokers. The first law restricting smoking in public places was enacted in 1973 in Arizona that followed the 1972 Surgeon General’s Report providing awareness of the negative health effects associated with the exposure to air pollution from tobacco smoke. Smoke-free laws were slowly enacted after this time point with most occurring after the year 2000. In July 2007, the Smoke Free Illinois Act (SB0500, Public Act 095-0017) was passed in IL. The ban went into effect on Jan 1, 2008 and Illinois joined 22 other states in prohibiting smoking in virtually all public places and workplaces including offices, theaters, museums, libraries, schools, commercial establishments, retail stores, bars, private clubs, and gaming facilities. While many studies have examined the effect of smoking bans on hospitalizations, this study would be the first to examine the effect of the comprehensive smoking ban in IL on ED visits by utilizing chronic disease categories created with ED chief complaint data captured by syndromic surveillance. The author hypothesizes that the comprehensive smoking ban in IL significantly reduced the ED visits associated with AMI, ACS, stroke, and COPD in adults in Cook County, IL.

Objective:

To utilize ED chief complaint data obtained from syndromic surveillance to quantify the effect of the Illinois smoking ban on acute myocardial infarction (AMI), acute coronary syndrome (ACS), stroke, and chronic obstructive pulmonary disease (COPD) related ED visits in adults in Cook County, IL.

Opioid overdoses are a growing cause of mortality in the United States. Medical prescriptions for opioids are a risk factor for overdose. This observation raises concerns that patients may seek multiple opioid prescriptions, possibly increasing their overdose risk. One route for obtaining those prescriptions is visiting the emergency department (ED) for pain-related complaints. Here, two hypotheses related to prescription seeking and overdoses are tested. (1) Overdose patients have a larger number of prior ED visits than matched controls. (2) Overdose patients have distinct patterns of pain-related complaints compared to matched controls.

Objective:

Identifying text features of emergency department visits associated with risk of future drug overdose.