Syndromic Surveillance

Extreme heat and related illnesses are a critical concern in Arizona from May to September each year. From 2008 to 2016, Arizona medical facilities had an average of 1,790 emergency visits and 442 hospital admissions for heat-related illnesses (HRI) during the summer months. In 2016 alone, Arizona Emergency Departments (EDs) received a total of 2,484 visits for HRI and 527 of these cases were admitted as inpatients1. Pinal County, which has an estimated population of 430,237 individuals, contributes to the number of HRI visits to Arizona Emergency Departments that occur each year. In order to determine the burden of HRIs within the county, Pinal County Public Health Services District (PCPHSD) began to conduct heat-related illness surveillance in 2017 and found that 149 HRI cases had been reported that year3. PCPHSD continued to conduct HRI surveillance through summer 2018 to build on surveillance activities from 2017 and meet the following goals: 1) improve HRI case identification and assessment through enhanced HRI surveillance and interview processes, 2) determine risk factors and risk populations for HRIs in Pinal County, and 3) recommend and implement practical interventions to prevent HRIs among Pinal residents.

Objective: Determine risk factors and risk populations for heat-related illnesses in Pinal County, AZ by improving HRI case identification and assessment.

As part of the French syndromic surveillance system SurSaUDî, the French Public Health Agency (Sant© publique France) collects daily data from the emergency department (ED) network OSCOUR®. The system aims to timely identify, follow and assess the health impact of unusual or seasonal events on emergency medical activity. Individual ED data contain demographic (age, gender, residence zip code), administrative (dates of attendances and discharge, ED, etc.) and medical information (chief complaint, main and associated medical diagnoses, severity). Medical diagnoses are encoded using the ICD10 classification. Then syndromic groups are built based on these ICD10 codes for ensuring syndromic surveillance in routine. Even if ICD10 is recommended on the national guidelines for coding ED attendances, this thesaurus offers a too large variety of codes. Particularly, it includes lots of diseases that may never be observed or confirmed in ED. This variety let selection of the appropriate codes difficult for physicians in a reactive use and could discourage them to code diagnoses. In order to encourage appropriate and reactive coding practice, we decided in 2017 to produce a new diagnoses thesaurus with a limited list of ICD10 codes. Then a committee of medical and epidemiological experts was created by the Federation of regional emergency observatories (FedORU), to propose an operational thesaurus that includes relevant codes for both ED in a daily routine practice and syndromic surveillance.

Objective: The study aims to evaluate the potential impact of the revision of the thesaurus used by ED physicians to code medical diagnoses, on the syndromic indicators used daily to achieve the detection objective of the French syndromic surveillance system.

On August 25, 2017 Hurricane Harvey moved onshore near Port Aransas, Texas, eventually overwhelming areas of Houston with between 41-60 inches of rain (Houston Health Department [HHD], 2017). As a category 4 storm, with wind speeds as high as 130 mph, Harvey broke several rainfall records across the state and ended the prolonged period of twelve years in which no major hurricanes had made landfall in the United States (Mersereau, 2017). Harvey ambled at a leisurely pace through Houston and resulted in devastating flooding that destroyed homes and required the evacuation of approximately 37,000 Houstonians to over 78 shelter facilities across the affected area (HHD, 2017). Through concerted efforts, the American Red Cross and the HHD established the shelter at the George R. Brown Convention Center (GRB) and delivered or coordinated social services, medical and mental health services, disease surveillance and food/sanitary inspection services for the duration of the need for the shelter (HHD, 2017).

Objective: To provide recommendations for future preparedness response efforts based on an assessment of the Post-Hurricane Harvey After-Action Report (AAR).

In Reunion Island, a French overseas territory located in the southwestern of Indian Ocean, the dengue virus circulation is sporadic. Since 2004, between 10 and 221 probable and confirmed autochthonous dengue fever cases have been reported annually. Since January 2018, the island has experienced a large epidemic of DENV serotype 2. As of 4 September 2018, 6,538 confirmed and probable autochthonous cases have been notified1. From the beginning of the epidemic, the regional office of National Public Health Agency (ANSP) in Indian Ocean enhanced the syndromic surveillance system in order to monitor the outbreak and to provide hospital morbidity data to public health authorities.

Objective: To describe the characteristics of ED vitis related to dengue fever and to show how the syndromic surveillance system can be flexible for the monitoring of this outbreak.

Icy weather events increase the risk for injury from falls on untreated or inadequately treated surfaces. These events often result in ED visits, which represents a significant public health and economic impact1. The goal of this project was to start the process toward an evaluation of the public health impact and the economic impact of falls associated to icy weather in Douglas County, NE for the ultimate purpose of designing and implementing injury prevention related public health protection measures. Additionally, the validated definition will be used by NE DHHS Occupational Health Surveillance Program to identify work related ice-related fall injuries that were covered by workers compensation. To achieve the goal, the first step was to identify a valid and reliable syndromic surveillance. Specifically, this project looked at the applicability of the ESSENCE syndromic surveillance definitions related to injuries associated with falls. Two syndromic surveillance definitions were compared, one that includes triage note and chief complaint search terms, and another that only includes chief complaint. The hypothesis was that the ESSENCE syndromic surveillance definition that includes triage note and chief complaint search terms, rather than the syndromic surveillance definition that only includes chief complaint, would be more effective at identifying ED visits resulting from fall-related injuries.

Objective: This project evaluated and compared two ESSENCE syndromic surveillance definitions for emergency department (ED) visits related to injuries associated with falls in icy weather using 2016-2017 data from two hospitals in Douglas County, Nebraska. The project determined the validity of the syndromic surveillance definition as applied to chief complaint and triage notes and compared the chief complaint data alone to chief complaint plus triage notes definitions to find the most reliable definition for ED visits resulting from fall-related injuries.

Syndromic surveillance achieves timeliness by collecting prediagnostic data, such as emergency department chief complaints, from the start of healthcare interactions. The tradeoff is less precision than from diagnosis data, which takes longer to generate. As the use and sophistication of electronic health information systems increases, additional data that provide an intermediate balance of timeliness and precision are becoming available. Information about the procedures and treatments ordered for a patient can indicate what diagnoses are being considered. Procedure records can also be used to track the use of preventive measures such as vaccines that are also relevant to public health surveillance but not readily captured by typical syndromic data elements. Some procedures such as laboratory tests also provide results which can provide additional specificity about which diagnoses will be considered. If procedure and treatment orders and test results are included in existing syndromic surveillance feeds, additional specificity can be achieved with timeliness comparable to prediagnostic assessments.

Objective: To identify additional data elements in existing syndromic surveillance message feeds that can provide additional insight into public health concerns such as the influenza season.

Since 2008, drug overdose deaths exceeded the number of motor vehicle traffic-related deaths in Indiana, and the gap continues to widen1. While federal funding opportunities are available for states, it often takes years for best practices to be developed, shared, and published. Similarly, local health departments (LHDs) may experience lengthy delays to receive finalized county health statistics. Indiana collects and stores syndromic emergency department data in the Public Health Emergency Surveillance System (PHESS) and uses the Electronic Surveillance System for the Early Notification of Community-based Epidemics version 1.21 (ESSENCE) to monitor public health events and trends. In July 2017, the Indiana Overdose Surveillance Team (IOST) developed a standard process for monitoring and alerting local health partners of increases in drug overdoses captured in ESSENCE at the county level. ISDH is enhancing these alerts by mapping the data in GIS and providing spatiotemporal data to LHDs to inform more targeted intervention and prevention efforts.

Objective: This poster presentation shares Indiana's approach of alerting local health departments (LHDs) with near real-time drug overdose data and how this process has been enhanced through mapping and analysis with a geographic information system (GIS).

Disease surveillance is an integral part of public health system. It is an epidemiological method for monitoring disease patterns and trends. International Health Regulation (IHR) 2005 obligates WHO member countries to develop an effective disease surveillance system. Bangladesh is a signatory to IHR 2005. Institute of Epidemiology, Disease Control and Research (IEDCR ) is the mandated institute for surveillance and outbreak response on behalf of Government of the People's Republic of Bangladesh. The IEDCR has a good surveillance system including event-based surveillance system, which proved effective to manage public health emergencies. Routine disease profile is collected by Management Information System (MIS) of Directorate General of Health Services (DGHS). Expanded Program of Immunization (EPI) of DGHS collect surveillance data on EPI-related diseases. Disease Control unit, DGHS is responsible for implementing operational plan of disease surveillance system of IEDCR. The surveillance system maintain strategic collaboration with icddrr.

Objective: a) To observe trends and patterns of diseases of public health importance and response; b) To predict, prevent, detect, control and minimize the harm caused by public health emergencies; c) To develop evidence for managing any future outbreaks, epidemic and pandemic.

Evidence about the value of syndromic surveillance data for outbreak detection is limited. In July 2018, a salmonellosis outbreak occurred following a family reunion of 300 persons held in Camden County, Georgia, where one meal was served on 7/27/2018 and on 7/28/2018.

Objective: Describe how the Georgia Department of Public Health (DPH) used data from its State Electronic Notifiable Disease Surveillance System (SendSS) Syndromic Surveillance (SS) module for early detection of an outbreak of salmonellosis in Camden County, Georgia.

Syndromic surveillance systems, although initially developed in response to bioterrorist threats, are increasingly being used at the local, state, and national level to support early identification of infectious disease and other emerging threats to public health. To facilitate detection, one of the goals of CDC's National Syndromic Surveillance Program (NSSP) is to develop and share new sets of syndrome codes with the syndromic surveillance Community of Practice. Before analysts, epidemiologists, and other practitioners begin customizing queries to meet local needs, especially monitoring ED visits in near-real time during public health emergencies, they need to understand how syndromes are developed. More than 4,000 hospital routinely send data to NSSP's BioSense Platform, representing about 55 percent of ED visits in the United States (2). The platform's surveillance component, ESSENCE,* is a web-based application for analyzing and visualizing prediagnostic hospital ED data. ESSENCE's Chief Complaint Query Validation (CCQV) data source, which is a national-level data source with access to chief complaint (CC) and discharge diagnoses (DD) from reporting sites, was designed for testing new queries.

Objective: Emergency department (ED) visits related to mental health (MH) disorders have increased since 2006 (1), indicating a potential burden on the healthcare delivery system. Surveillance systems has been developed to identify and understand these changing trends in how EDs are used and to characterize populations seeking care. Many state and local health departments are using syndromic surveillance to monitor MH-related ED visits in near real-time. This presentation describes how queries can be created and customized to identify select MH sub-indicators (for adults) by using chief complaint text terms and diagnoses codes. The MH sub-indicators examined are mood and depressive disorders, schizophrenic disorders, and anxiety disorders. Wider adoption of syndromic surveillance for characterizing MH disorders can support long-term planning for healthcare resources and service delivery.