Syndromic Surveillance

On October 2016, the Indian Ocean Regional Health Agency was alerted about an increase in ED visits related to adverse reactions associated with use of SC on Mayotte Island. In this context, an investigation based on a syndromic surveillance system was implemented by the regional unit of the French national public health agency.

Objective:

To confirm and to characterize the increase in emergency department (ED) visits related to the use of synthetic cannabinoids (SC).

Syndromic Surveillance (SS), traditionally applied to infectious diseases, is more recently being adapted to chronic disease prevention. Its usefulness rests on the large number of diverse individuals visiting emergency rooms with the possibility of real-time monitoring of acute health effects, including effects from environmental events and its potential ability to examine more long-term health effects and trends of chronic diseases on a local level.

Objective:

To create chronic disease categories for emergency department (ED) chief complaint data and evaluate the categories for validity against ED data with discharge diagnoses and hospital discharge data.

Syndromic surveillance uses near-real-time emergency department and other health care data for enhancing public health situational awareness and informing public health activities. In recent years, continued progress has been made in developing and strengthening syndromic surveillance activities. At the national level, syndromic surveillance activities are facilitated by the National Syndromic Surveillance Program (NSSP), a collaboration among state and local health departments, the CDC, other federal organizations, and other organizations that enabled collection of syndromic surveillance data in a timely manner, application of advanced data monitoring and analysis techniques, and sharing of best practices. This panel will highlight the importance of success stories. Examples of successes from state and local health departments will be presented and the audience will be encouraged to provide feedback.

Objective:

This panel will: 

• Discuss the importance of identifying and developing success stories
• Highlight successes from state and local health departments to show how syndromic surveillance activities enhance situational awareness and address public health concerns
• Encourage discussion on how to further efforts for developing and disseminating success stories.

Syndromic surveillance uses near-real-time Emergency Department healthcare and other data to improve situational awareness and inform activities implemented in response to public health concerns. The National Syndromic Surveillance Program (NSSP) is a collaboration among state and local health departments, the Centers for Disease Control and Prevention (CDC), other federal organizations, and other entities, to strengthen the means for and the practice of syndromic surveillance. NSSP thus strives to strengthen syndromic surveillance at the national and the state, and local levels through the coordinated activities of the involved partners and the development and use of advanced technologies, such as the BioSense platform. Evaluation and performance measurement are crucial to ensure that the various strategies and activities implemented to strengthen syndromic surveillance capacity and practice are effective. Evaluation activities will be discussed at this session and feedback from audience will be sought with the goal to further strengthen evaluation activities in the future. 

Objective:

The objective of this session is to discuss syndromic surveillance evaluation activities. Panel participants will describe contexts and importance of selected evaluation and performance measurement activities in NSSP. Discussions will explore ways to strengthen evaluation in syndromic surveillance activities in the future.

Since 2008, drug overdose deaths exceeded the number of motor vehicle traffic-related deaths in Indiana and the gap continues to widen1. As the opioid crisis rages on in the United States the federal government is providing funding opportunities to states, but it often takes years for best practices to be developed, shared, and published. Indiana State Department of Health (ISDH) has developed a standard process for monitoring and alerting local health partners of increases in drug overdoses captured in Indiana’s syndromic surveillance system (ESSENCE). ISDH is launching a pilot project to encourage local partners to start a conversation about overdose response capabilities and planning efforts in their community. Other states have published articles about drug overdose syndromic surveillance (SyS) data being used to inform local public health action, however, the local overdose response activity details were vague 2,3. With the opioid crisis continuing to spiral out of control in the United States, it is imperative to work together as local, state, and national partners to find potential solutions to this crisis.

Objective:

The overall objective of this session is to discuss opportunities to use drug overdose syndromic surveillance (SyS) data to encourage action among local public health partners. After this roundtable discussion, participants will be able to:

• Identify opportunities to promote use of drug overdose SyS data to their health partners.
• Plan for potential drug overdose public health interventions.
• Develop relationships with roundtable attendees to continue the conversation and sharing of ideas about use of drug overdose SyS data.

As part of a wide-spread community discussion on the presence of monuments to Confederate Civil War figures, the Charlottesville city council voted to remove a statue of General Robert E. Lee. Multiple rallies were then held to protest the statue’s removal. A Ku Klux Klan (KKK) rally on July 8, 2017 (MMWR Week 27) and a Unite the Right rally on August 12, 2017 (MMWR Week 32) held in Charlottesville both resulted in violence and media attention. The violence associated with the Unite the Right rally included fatalities connected to motor vehicle and helicopter crashes. Syndromic surveillance has been used to study the impact of terrorism on a community’s mental health while more traditional data sources have looked at the impact of racially-charged civil unrest. Syndromic surveillance, however, has not previously been used to document the effect of racially-charged violence on the health of a community.

Objective:

To describe the impact of civil unrest on the mental health of a community in near real-time using syndromic surveillance.

In May 2015, the MERS-CoV outbreaks in South Korea was sparkled from a hospital of Gyeonggi-do province. In response to this outbreak, the provincial government and infectious disease control center (GIDCC) initiated an emergency department (ED) based Gyeonggi-do provincial acute febrile illness (AFI) surveillance network (GAFINet) to monitor for a subsequent outbreak of emerging or imported infectious diseases since September 2016. Gyeonggi-do province is located in the North-West of South Korea, surrounds the capital city Seoul, and borders North Korea (Figure 1). Considering the geographical coverage, GAFINet Initiative involves ten hospitals, consisted of four university-affiliated hospitals and six provincial medical centers in Gyeonggi-do province. These hospitals participated in this network voluntarily, and most staffs including five infectious diseases specialists had direct or indirect experiences in dealing with MERS-CoV patients.

Objective:

The objectives are to introduce a provincial level surveillance system, which has been initiated in response to the MERS-CoV outbreak of South Korea, and describe findings from systematic investigation of individual admissions attributed to acute febrile illness for the first year.`

Between 2006 and 2013, the rate of emergency department (ED) visits related to mental and substance use disorders increased substantially. This increase was higher for mental disorders visits (55 percent for depression, anxiety or stress reactions and 52 percent for psychoses or bipolar disorders) than for substance use disorders (37 percent) visits. This increasing number of ED visits by patients with mental disorders indicates a growing burden on the health-care delivery system. New methods of surveillance are needed to identify and understand these changing trends in ED utilization and affected underlying populations. Syndromic surveillance can be leveraged to monitor mental health-related ED visits in near real-time. ED syndromic surveillance systems primarily rely on patient chief complaints (CC) to monitor and detect health events. Some studies suggest that the use of ED discharge diagnoses data (Dx), in addition to or instead of CC, may improve sensitivity and specificity of case identification.

Objective: The objectives of this study are to

(1) create a mental health syndrome definition for syndromic surveillance to monitor mental health-related ED visits in near real time;

(2) examine whether CC data alone can accurately detect mental health related ED visits; and

(3) assess the added value of using Dx data to detect mental health-related ED visits.

Syndromic surveillance is the monitoring of symptom combinations (i.e., syndromes) or other indicators within a population to inform public health actions. The Tennessee Department of Health (TDH) collects emergency department (ED) data from more than 70 hospitals across Tennessee to support statewide syndromic surveillance activities. Hospitals in Tennessee typically provide data within 48 hours of a patient encounter. While syndromic surveillance often supplements disease- or condition-specific surveillance, it can also provide general situational awareness about emergency department patients during an event or response. During Hurricanes Harvey (continental US landfall on August 25, 2017) and Irma (continental US landfall on September 10, 2017), TDH supported all hazards situational awareness using the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE) in the BioSense Platform supported by the National Syndromic Surveillance Program (NSSP). The volume of out-of-state patients in Tennessee was monitored to assess the impact on the healthcare system and any geographic- or hospital-specific clustering of out-of-state patients within Tennessee. Results were included in daily State Health Operations Center (SHOC) situation reports and shared with agency response partners such as the Tennessee Emergency Management Agency (TEMA).

Objective:

To demonstrate the use of ESSENCE in the BioSense Platform to monitor out-of-State patients seeking emergency healthcare in Tennessee during Hurricanes Harvey and Irma.

While UC does not have a standard definition, it can generally be described as the delivery of ambulatory medical care outside of a hospital emergency department (ED) on a walk-in basis, without a scheduled appointment, available at extended hours, and providing an array of services comparable to typical primary care offices. UC facilities represent a growing sector of the United States healthcare industry, doubling in size between 2008 and 2011. The Urgent Care Association of America (UCAOA) estimates that UC facilities had 160 million patient encounters in 2013. This compares to 130.4 million patient encounters in EDs in 2013, as reported by the National Hospital Ambulatory Medical Care Survey. Public Health (PH) is actively working to broaden syndromic surveillance to include urgent care data as more individuals use these services. PH needs justification when reaching out to healthcare partners to get buy-in for collecting and reporting UC data.

Objective:

Provide justification for the collection and reporting of urgent care (UC) data for public health syndromic surveillance.