Syndromic Surveillance

On January 2, 2014 the cyclone Bejisa struck Reunion Island. This storm of Category 3 (Saffir–Simpson scale) disturbed electricity supply and drinking water systems. Floods, roof destructions and the threat of landslide led to the evacuation of residents to emergency shleters. In this context, the regional office of French Institute for Public Health Surveillance in Indian Ocean set up an epidemiological surveillance in order to assess the impact in the aftermath of the cyclone.

Objective

To assess the health impact of cyclone Bejisa from data of emergency departments (EDs) and emergency medical service (EMS)

Syndromic surveillance is one of the meaningful use public health menu set objectives for eligible professionals. The value of this data for syndromic surveillance as an adjunct to the more widely adopted emergency department registrations has not been studied extensively. It may be that it would improve the sensitivity or timeliness of detecting certain communicable disease events, or it may just contain signals comparable to what is available via other syndromic surveillance data streams. The value of making the effort to collect this data is considered contingent on the answer to that question.

Public health is concerned with more than just communicable diseases, however. Chronic diseases and their underlying causes are also a significant public health concern. Obesity alone is estimated to be responsible for 2.5% of the global disease burden, and represents a higher fraction in many developed nations. Since chronic diseases are not associated with singular events of brief duration, they are difficult to track with traditional surveillance methods. They are also not typically managed via emergency departments, so syndromic surveillance does not capture them well either.

Chronic diseases are often treated by physicians at ambulatory practices. Thus data from eligible professionals may provide a means for monitoring chronic diseases, or metrics associated with chronic diseases, that would not otherwise be as feasible. As a proof of concept, this study seeks to determine if body mass index (BMI), the standard measure of obesity, can be obtained from ambulatory syndromic surveillance messages.

Objective

To demonstrate the utility of ambulatory syndromic surveillance data to public health domains beyond communicable diseases

Centers for Disease Control and Prevention’s (CDC) BioSense system receives near real-time health care utilization data from number of sources, including DoD and VA outpatient facilities, and nonfederal hospital EDs in the US to support all-hazards surveillance and situational awareness. However, the BioSense system lacks some critical functions such as creating ad hoc definition of syndrome or ad hoc query tool development. This limits CDC Emergency Operations Center’s (EOC) ability to monitor new health events such as MERS - a viral respiratory illness first reported in Saudi Arabia in 2012. In May 2014, CDC confirmed two unlinked imported cases of MERS in the US - one in Indiana, the other in Florida. Upon report of a MERS case in Indiana, staff initiated joint efforts with EOC and several affected jurisdictions to enhance the surveillance of MERS irrespective of jurisdictions’ preferred surveillance system.

Objective

To identify and monitor Middle East Respiratory Syndrome (MERS) like syndromes cases in the syndromic surveillance system.

Drug overdoses and related deaths have been escalating nationally since 1970. In Virginia, the rate of drug overdose deaths increased 36% from 5.0 to 6.8 deaths per 100,000 population between 1999 and 2010. While initiated for bioterrorism event detection, syndromic surveillance has shown utility when extended to other health issues. ED visits may complement information from Overdose Deaths investigated by the Office of the Chief Medical Examiner (OCME) in describing drug overdose trends. Due to its real-time nature, syndromic surveillance data could act as an early indicator for emerging drug problems in the community, serving as an alert to public health.

Objective

Determine if syndromic surveillance data can be used to provide a real-time picture of the drug using population by analyzing trends of emergency department (ED) visits for unintentional drug overdose (Overdose Visits) in conjunction with unintentional deaths that prescription or illicit opiates contributed to or caused (Overdose Deaths).

HIV post-exposure prophylaxis (PEP) involves taking antiretroviral medication after potential exposure to HIV to reduce the probability of becoming infected. New York State recommends PEP following certain occupational (e.g., needle sticks by healthcare workers) and non-occupational (e.g., sexual and needle-sharing activities) exposures. Little information exists on the uptake of PEP for HIV in the United States, particularly with regard to nonoccupational exposures. ED data have been used previously to identify occupational PEP visits but have not been used extensively to describe trends in PEP visits overall. We aimed to identify HIV-related PEP visits in NYC EDs to track uptake and inform outreach efforts.

Objective

To describe trends in HIV post-exposure prophylaxis uptake in New York City (NYC) emergency departments (EDs).

Biosurveillance Portal (BSP) is a web-based enterprise environment that is aimed to facilitate international collaboration, communication, and information-sharing in support of the detection, management, and mitigation of biological events in Korea. In Oct 2013, Republic of Korea (ROK) Ministry of National Defense has made the project agreement with United States (US) Department of Defense Joint Program Executive Office of Chemical and Biological Defense to develop Biosurveillance Portal which will provide tools and capabilities to facilitate timely identification and detection of biological events to minimize operational impacts on ROK-US Forces. As a part of this project, Armed Forces Medical Command (AFMC) undertook the initiative to develop the Military Active Realtime Syndromic Surveillance system.

Objective

This presentation aims to elaborate our experiences from initiating a syndromic surveillance system as a part of current biosurveillance developments in Korea. We developed Military Active Realtime Syndromic Surveillance (MARSS) system with data from all of 19 Korean military hospitals as a part of the US-ROK joint Biosurveillance Project.

Recent efforts to share syndromic surveillance data have focused on developing national systems, namely BioSense 2.01 . The problems with creating and implementing national systems, such as legal issues, difficulties in standardizing syndrome definitions, data quality, and different objectives, are well documented. In contrast, several local health departments have successfully shared data and analyses with each other, primarily during emergency events. The benefits of locally-driven data sharing include: (1) faster dissemination of data and analyses that have been created by those who understand the nuances of their own data, (2) easier process of standardizing syndrome definitions, (3) quickly designing appropriate analyses for the event, (4) smaller group of partners for consensus-building, and (5) ultimately improved timeliness in detection of public health events. The strategies used to share data and analyses between local and state health departments during planned and unplanned events may be informative to national systems.

Objective

To outline successful strategies for regional data-sharing and discuss how these strategies can be applied to other regions.

Meaningful Use (MU) Stage 2 public health reporting for Eligible Professionals (EPs) included a menu option for ambulatory syndromic surveillance. Review of currently existing models lead to a collaboration between the Illinois Health Information Exchange (ILHIE) and IDPH to build services that would support the use of the MPI, a database that can uniquely match records across systems. The MPI providers a mechanism for public health to manage multiple data streams, while maintaining confidentiality of health information and supporting the mission of public health to identify patterns of illness, apply effective interventions and conduct program evaluation. This initiative will allow IDPH to extend the use of the MPI to other surveillance domains, including hospital discharge, communicable disease, cancer and extensively drug resistance organism reporting.

Objective

This presentation will describe public health efforts to improve data collection by utilizing technology that supports record linkage through the implementation of the Master Patient Index (MPI). The initial use case will be applied to ambulatory syndromic surveillance at Illinois Department of Public Health (IDPH). It will include applications for incorporating the MPI into currently existing public health surveillance data and benefits to data integration and bidirectional information exchange.

Along with commensurate funding, an increased emphasis on syndromic surveillance systems occurred post September 11, 2001 and the subsequent anthrax attacks. Since then, many syndromic surveillance systems have evolved and have ever-increasing functionality and visualization tools. As outbreak detection using these systems has demonstrated an equivocal track record, epidemiologists have sought out other interesting and unique uses for these systems. Over the numerous years of the International Society for Disease Surveillance (ISDS) conference, many of these studies have been presented, however, there has been a dearth of discussion related to how these systems should be used on a routine basis. As the initial goal of these systems was to provide a near real-time disease surveillance tool, the question of how to most effectively conduct this type of routine surveillance is paramount.

Objective

To discuss how various emergency department based syndromic surveillance systems from across the country and world are being used and to develop best practices for moving forward.