Syndromic Surveillance

On July 22, 2016, the Sand Fire began burning in the Santa Clarita Valley of Los Angeles County (LAC), CA. This urban-adjacent wildfire breached the city limits of Santa Clarita (population 180,000). Fueled by record heat and an ongoing exceptional drought, the Sand Fire burned over 40,000 acres in 13 days and caused a large increase in the air concentration of fine particulate matter. The syndromic surveillance team was tasked with reporting on possible health effects from the fire. Fire, asthma, and heat related data were monitored until the fire was reported as 98% contained. The team prepared and distributed a daily special summary report to key stakeholders in the LAC Department of Public Health. 

Objective

To detect increases in health complaints resulting from the July 2016 Sand Fire near Santa Clarita, CA using syndromic surveillance and complementary systems. 

The first travel-associated cases of Zika virus infection in New York City (NYC) were identified in January 2016. Local transmission of Zika virus from imported cases is possible due to presence of Aedes albopictus mosquitos. Timely detection of local Zika virus transmission could inform public health interventions and mitigate additional spread of illness. Daily emergency department (ED) visit surveillance to detect individual cases and spatio-temporal clusters of locally-acquired Zika virus disease was initiated in June 2016. 

Objective

Case and cluster identification of emergency department visits related to local transmission of Zika virus. 

From 2001-2011, mental health-related hospitalizations and ED visits increased among United States children nationwide. During this period, mental health-related hospitalizations among NYC children increased nearly 23%. To estimate mental health-related ED visits in NYC and assess the use of syndromic surveillance chief complaint data to monitor these visits, we compared trends from a near real-time syndromic system with those from a less timely, coded ED visit database. 

Objective

To assess the use of syndromic surveillance to assess trends in mental health-related emergency department (ED) visits among school-aged children and adolescents in New York City (NYC). 

Human MERS-CoV was first reported in September 2012. Globally, all reported cases have been linked through travel to or residence in the Arabian Peninsula with the exception of cases associated with an outbreak involving multiple health care facilities in the Republic of Korea ending in July 2015. While the majority of MERS-CoV cases have been reported in the Arabian Peninsula, several cases have been reported outside of the region. Most cases are believed to have been acquired in the Middle East and then exported elsewhere, with no or rare instances of secondary transmission. Two cases of MERS-CoV were exported to the United States and identified in May 2014. One of these cases traveled from Saudi Arabia to Florida.

DOH conducts regular surveillance for MERS-CoV through the investigation of persons with known risk factors. PUIs have most often been identified by physicians reporting directly to local health departments and by DOH staff regularly querying ED and UCC chief complaint data in ESSENCE-FL. ESSENCE-FL currently captures data from 265 EDs and UCCs statewide and has been useful in identifying cases associated with reportable disease and emerging pathogens. 

Objective

To retrospectively identify initial emergency department (ED) and urgent care center (UCC) visits for Florida’s Middle East respiratory syndrome coronavirus disease (MERS-CoV) patients under investigation (PUIs) in the Florida Department of Health’s (DOH) syndromic surveillance system, the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE-FL), using information gathered from PUI case report forms and corresponding medical records for the purpose of improving syndromic surveillance for MERS-CoV. The results of this study may be further utilized in an effort to evaluate the current MERS-CoV surveillance query. 

Nearly all of the myriad activities (or use cases) in clinical and public health (e.g., patient care, surveillance, community health assessment, policy) involve generating, collecting, storing, analyzing, or sharing data about individual patients or populations. Effective clinical and public health practice in the twenty-first century requires access to data from an increasing array of information systems, including but not limited to electronic health records. However, the quality of data in electronic health record systems can be poor or “unfit for use.” Therefore measuring and monitoring data quality is an essential activity for clinical and public health professionals as well as researchers. 

Objective

To extend an open source platform for measuring the quality of electronic health data by adding functions useful for syndromic surveillance 

The 2016 U.S. Olympic Track and Field Team Trials were held July 1-10 in Eugene, OR. This mass gathering included over 1,000 athletes, 1,500 volunteers, and 175,000 spectators. The Oregon Public Health Division (PHD) and Lane County Public Health (LCPH) participated in pre-event planning and collaborated to produce a daily epidemiology report for the Incident Management Team (IMT) during the event. The state and county public health agencies had collaborated on surveillance for prior mass gatherings, including the 2012 Trials. However, 2016 was the first opportunity to use complete state and county syndromic surveillance data. 

Objective

To streamline production of a daily epidemiology report including syndromic surveillance, notifiable disease, and outbreak data during a mass gathering. 

Syndromic surveillance is an alternative type of public health surveillance which utilizes pre-diagnostic data sources to detect outbreaks earlier than conventional (laboratory) surveillance and monitor the progression of illnesses in populations. These systems are often noted for their ability to detect a wider range of cases in under- reported illnesses, utilize existing data sources, and alert public health authorities of emerging crises. In addition, they are highly versatile and can be applied to a wide range of illnesses (communicable and non-communicable) and environmental conditions. As a result, their implementation in public health practice is expanding rapidly. This scoping review aimed to identify all existing literature detailing the necessary components in the defining, creating, implementing, and evaluating stages of human infectious disease syndromic surveillance systems. 

Public Health England (PHE) uses syndromic surveillance systems to monitor for seasonal increases in respiratory illness. Respiratory illnesses create a considerable burden on health care services and therefore identifying the timing and intensity of peaks of activity is important for public health decision-making. Furthermore, identifying the incidence of specific respiratory pathogens circulating in the community is essential for targeting public health interventions e.g. vaccination. Syndromic surveillance can provide early warning of increases, but cannot explicitly identify the pathogens responsible for such increases.

PHE uses a range of general and specific respiratory syndromic indicators in their syndromic surveillance systems, e.g. “all respiratory disease”, “influenza-like illness”, “bronchitis” and “cough”. Previous research has shown that “influenza-like illness” is associated with influenza circulating in the community1 whilst “cough” and “bronchitis” syndromic indicators in children under 5 are associated with respiratory syncytial virus (RSV)2, 3. However, the relative burden of other pathogens, e.g. rhinovirus and parainfluenza is less well understood. We have sought to further understand the relationship between specific pathogens and syndromic indicators and to improve estimates of disease burden. Therefore, we modelled the association between pathogen incidence, using laboratory reports and health care presentations, using syndromic data. 

Objective

To improve understanding of the relative burden of different causative respiratory pathogens on respiratory syndromic indicators monitored using syndromic surveillance systems in England. 

From 1 September 2015, babies in the United Kingdom (UK) born on/after 1 July 2015 became eligible to receive the MenB vaccine, given at 2 and 4 months of age, with a booster at 12 months. Early trials found a high prevalence of fever (over 38°C) in babies given the vaccine with other routine vaccines at 2 and 4 months. We used syndromic surveillance data to assess whether there had been increased family doctor (general practitioner (GP)) consultations for fever in young infants following the introduction of the vaccine. 

Objective

To use syndromic surveillance data to assess whether there has been an increase in GP fever consultations since the inclusion of the meningococcal B (MenB) vaccine in the UK vaccination schedule.