Syndromic Surveillance

Whilst the sensitivity and specificity of traditional laboratory-based surveillance can be readily estimated, the situation is less clear cut for syndromic surveillance. Syndromic surveillance indicators based upon presenting symptoms, chief complaints or preliminary diagnoses are designed to provide public health systems with support to detect multiple potential threats to public health. There is however, no gold standard list of all the possible ‘events’ that should have been detected. This is especially true in emergency response where systems are designed to detect possible events for which there is no directly comparable historical precedent.

Objective

To devise a methodology for validating the effectiveness of syndromic surveillance systems across a range of public health scenarios, even in the absence of historical example datasets.

The Louisiana Office of Public Health (OPH) Infectious Disease Epidemiology Section conducts emergency department (ED) syndromic surveillance using the Louisiana Early Event Detection System (LEEDS). LEEDS automatically processes electronic chief complaint, admit reason and diagnosis data to identify ED visits indicative of specific syndromes. In response to local transmission of chikungunya virus in the Caribbean and the first travel-associated case in Louisiana in May of 2014, OPH conducted an arboviral syndromic surveillance study to validate arboviral syndromes and evaluate the utility and practicality of detecting and monitoring arboviral disease using ED chief complaint, admit reason and diagnosis text data.

Objective

To validate arboviral syndromes and evaluate the utility and practicality of detecting and monitoring arboviral disease using ED chief complaint, admit reason and diagnosis text data.

Rabies post-exposure prophylaxis (PEP) can prevent fatal encephalitis associated with exposure to the rabies virus. However, overuse and inappropriate administration of rabies PEP are common.1 Mandatory reporting of potential rabies exposures provides opportunities for public health practitioners to monitor the appropriateness of PEP administration and offer recommendations. In Illinois, potential human exposure to rabies, including any person started on PEP and any person with contact to a bat, must be reported to the local health authority. Previous investigations into the completeness of rabies reporting have concluded that active surveillance in addition to mandatory reporting may be useful.2 As rabies PEP is often given in an emergency department setting, syndromic surveillance records may provide a basis for estimating completeness of reporting and identifying candidates for active surveillance follow up.

Objective

To determine whether unreported cases of potential human exposure to rabies can be detected using an emergency department (ED) syndromic surveillance system and to assess both reporting completeness and compliance with clinical guidelines related to rabies exposures in suburban Cook County.

Although national surveillance systems are maintained for human health (CDC) and for livestock disease (USDA); there is no network or data repository in the area of wildlife disease surveillance. Because emerging and re-emerging diseases severely affect wildlife populations, impact domestic and agricultural animals, and are a reservoir for zoonotic transmission, it is crucial to have early notification and recognition of disease patterns in wildlife populations. Due to fragmented systems of wildlife management, inconsistent investigation into sudden mortality events, and limited laboratory availability, there is not a single entity that is responsible for reporting disease events in North American wildlife populations.

Objective

The USGS National Wildlife Health Center in conjunction with federal, state, tribal partners proposed an event reporting system with current and historic information on wildlife morbidity and mortality events in North America. The vehicle to accomplish this goal is WHISPers, the Wildlife Health Information Sharing Partnership event reporting system. This system depicts laboratory confirmed wildlife mortality events using geospatial mapping capability. Data are collected by multiple partners to collectively enhance the understanding of disease in wildlife populations.

Effective real-time surveillance of infectious diseases must strike a balance between reliability and timeliness for early detection. Traditional syndromic surveillance utilizes limited sections of the EMR, such as chief complaints and/or diagnosis. However, other sections of the EMR may contain more pertinent information than what is captured in a brief chief complaint. These other EMR sections may provide relevant information earlier in the patient encounter than at the diagnosis or disposition stage, which can appear in the EMR up to 24 hours after the patient’s discharge. Comprehensive analysis may identify the most relevant section of EMRs for surveillance of all major infectious diseases, including ILI.

Objective

To investigate which section(s) of a patient’s electronic medical record (EMR) contains the most relevant information for timely detection of influenza-like illness (ILI) in the emergency department (ED).

During the past ten years, the syndromic surveillance has mainly developed thanks to clinical data sources (i.e. emergency department, emergency medical call system, etc.). However, in these systems, the population doesn’t play an active role. It is now important that the population becomes an actor of this surveillance; especially since several European experiences about influenza showed that the population could participate to an internet-based monitoring. In Reunion Island, the population is very sensitive to public health concerns. In this context, the health authorities implemented since April 2014 a web-based surveillance system, called “Koman i lé”, that allows to follow the perceived health among people who don’t systematically see their general practitioner.

Objective

To describe a new surveillance system based on an online selfreported symptoms and to present the first results.

With economic pressures to shift the care of community-acquired pneumonia (CAP) to the ambulatory setting, there is a need to ensure safety of outpatients with CAP. The use of claims data alone remains the primary strategy for identifying these patients, but billing information often does not match the clinical diagnosis and does not have the ability to find unrecognized cases. In our previous work, an automated pneumonia case detection algorithm (CDA) was able to detect cases of CAP with positive predictive value of 71%. For this study, we begin to illustrate how this type of surveillance system may assist in evaluating the quality of outpatient care for CAP.

Integrated Disease Surveillance and Response (IDSR) is a World Health Organization (WHO) Regional Office for Africa (AFRO) strategy for strengthening national public health surveillance and response systems in African countries. The strategy incorporates the International Health Regulations (2005) core capacities for public health surveillance and response systems. Since 2010, more than 30 countries have conducted at least one IDSR training workshop. Limited resources preclude conducting workshops in each of the 4,500 districts in all WHO-AFRO region. One solution is to implement an electronic version for IDSR training.

In collaboration with WHO-AFRO, we conducted a literature search to identify e-Learning best practices, and transformed the IDSR workshop training materials into electronic modules using measurable performance objectives, realistic examples, meaningful practices, and real time feedback to the learner. We also utilized an online learning management platform that lets course managers track learner progress and share supporting materials. The IDSR e-Learning course, available in English, French and Portuguese, aims to increase access to skills that support the prevent-detect-respond goal areas of the Global Health Security Agenda.

Objective

This presentation addresses the challenges of expanding district level surveillance training in Africa. We developed an e-Learning course and field tested the modules using an innovative approach to assess the feasibility of delivering electronic surveillance training.