Microbial Threats to Health Emergence, Detection, and Response (2003) / Chapter Skim
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Appendix B: Syndromic Surveillance
Appendix B: Syndromic Surveillance
Pages 281-312
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From page 281... ...
Department of Medicine, University of Pennsylvania School of Medicine BACKGROUND Infectious disease threats, both naturally occurring and intentional, continue to challenge the medical and public health communities. Even before the tragic events of September 11, 2001, public health officials had begun a search for new and innovative methods to enhance the detection of emerging infections and illness due to bioterrorist agents.
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From page 282... ...
The availability of timely, flexible surveillance systems could have aided in characterizing and determining the scope of the outbreaks after their initial reporting. CDC notes several recent successes in strengthening surveillance efforts and in implementing new surveillance strategies, and has initiated the Epidemiology and Laboratory Capacity program to provide health departments with laboratory and technical capacity in dealing with emerging infections (CDC, 1998~.
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From page 283... ...
DEFINITIONS AND RATIONALE The covert aerosol release of a bioterrorist agent, such as anthrax, plague, or botulinum toxin, would require increased surveillance for illness by the public health and medical communities and rapid institution of illness prevention measures (Rotz et al., 2000~. With these agents, as well as with numerous naturally occurring emerging infections, people would likely present initially with nonspecific mild illness.
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From page 284... ...
Some authors have suggested that, given the level of importance associated with early detection of bioterrorist agents in initiating response, "extreme timeliness of detection" may become a new requirement of at least some public health surveillance systems (Wagner et al., 2001a)
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From page 285... ...
Drop-in syndromic surveillance, supported by local health departments and CDC, was implemented in Seattle for the 1999 World Trade Organization Meetings (Duchin, Public Health Seattle and King County, Personal Communication, 2002) , in the Washington metropolitan area for the 2001 presidential inauguration (Blythe, Maryland Department of Health and Mental Hygiene, Personal Communication, 2002; Sockwell, Virginia Department of Health (Northern Region)
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From page 286... ...
provider input informatics programming requlrec .; expertise; data available confidentiality continuously; data standardized Novel Active Easy to use; rapid Requires modes of Hand-held or touch provider feedback; providers input; collection screen devices can post alerts/info not sustainable Novel Active/passive Clearly defined Not an early sources Medical examiner "syndrome"; may be warning; of data data; supplemented with scalable unexplained death laboratory data or severe illness data SOURCES: This table was adapted from the following: Wagner et al., 2001a; Duchin et al., 2001; Pavlin, 2001; Lazarus et al., 2001; Moser et al., 1999; Zelicoff et al., 2001; Stanford report, 2001; Kluger et al., 2001; Rainbow et al., 2000.
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From page 287... ...
Despite the lack of baseline data for comparison and uncertainties regarding when and how to investigate "clusters" of particular syndromes, many local health departments across the country initiated similar efforts immediately following the terrorist attacks of September 11, 2001 (Blythe, Maryland Department of Health and Mental Hygiene, Personal Communication, 2002; Sockwell, Virginia Department of Health (Northern Region) , Personal Communication, 2002; Chernak, Philadelphia Department of Health, Personal Communication, 2001; Paladini, Bergen County Department of Health Services, Personal Communication, 2002~.
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From page 288... ...
and the emergency department chief complaintbased system in New York City (Mostashari, New York City Department of Health, Personal Communication, 2001) , collect data principally from .
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Because outbreak detection must necessarily precede post-attack prophylaxis or other control measures, rapid outbreak detection (by whatever means available)
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From page 290... ...
Public Health Authority Most local and state health departments interviewed for this report cited local public health laws that allow the collection of syndromic data (Blythe, Maryland Department of Health and Mental Hygiene, Personal Communication, 2002; Sockwell, Virginia Department of Health (Northern Region) , Personal Communication, 2002; Chernak, Philadelphia Department of Health, Personal Communication, 2001; Cody, Santa Clara County Department of Health Services, Personal Communication, 2002;
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From page 291... ...
, and coma/ sudden death. The drop-in surveillance systems implemented for the 2000 Republican and Democratic National Conventions used somewhat different categories: respiratory infection with fever, diarrhea/gastroenteritis, rash with fever, sepsis or nontraumatic shock, meningitis/encephalitis, botulismlike syndrome, and unexplained death with history of fever (Chernak, Philadelphia Department of Health, Personal Communication, 2001; Bancroft, County of Los Angeles, Department of Health Services, Personal Communication, 2002~.
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From page 292... ...
The Hawaii state health department reviewed retrospective data from a large statewide insurer used to collect ICD-9-CM codes for syndromic surveillance and found only about 20-30 percent accuracy in coding of infectious disease-related syndromes (Chang, Hawaii Department of Health, Personal Communication, 2002~. Investigators at the western Pennsylvania syndromic surveillance program evaluated ICD-9-CM-coded emergency department chief complaints by reviewing 800 emergency department records and determined the sensitivity of their acute respiratory illness syndrome codes was only 44 percent (Espino and Wagner, 2001~.
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From page 293... ...
Although several sites are exploring the use of school and work absenteeism (Mostashari, New York City Department of Health, Personal Communication, 2001; Hirshon, University of Maryland and Baltimore City Department of Health, Personal Communication, 2002) , as well as patterns of nonprescription medication sales, these data sources have not been validated and should be considered exploratory.
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From page 294... ...
Efforts to reduce delays in the transmission of electronic data should improve timeliness. The National Electronic Disease Surveillance System (NEDSS)
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From page 295... ...
The eHealth Initiative is a recently formed consortium of 60 health care organizations, including the majority of hardware and software suppliers to hospitals (eHealth Initiative website, 20011. The group, with CDC collaboration, aims to use existing information technology systems to enhance public health data collection a crucial early step in streamlining data flow.
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From page 296... ...
Security and Confidentiality Use of password-protected secure servers and removal of identifiers are the security methods most commonly reported by local health departments operating syndromic surveillance systems. Encryption, message authentication, and message nonrepudiation have been incorporated into systems depending on electronic transfer of large clinical data sets, such as the insurance claims data being received by the Hawaii Department of Health (Chang, Hawaii Department of Health, Personal Communication, 2002~.
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From page 297... ...
Public health officials in Hawaii, Seattle, and other settings have expressed concerns regarding the inability to access meaningful syndromic data because of HIPAA-related constraints cited by insurers or clinical/laboratory sources (Duchin, Public Health Seattle and King County, Personal Communication, 2002; Chang, Hawaii Department of Health, Personal Communication, 2002~. While health systems may access patient-specific data in response to syndromic aberrations or flags, public health departments may need to rely on clinical investigators on-site to review relevant data and determine the cause of aberrations and the need for additional investigation (MandI, Children's Hospital Boston, Personal Communication, 2002~.
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From page 298... ...
The New York City Department of Health is uses a scan statistic (Kulldorif, 2001) , a method that allows for identification of geographic clustering, to evaluate electronically transmitted emergency department triage log data (Mostashari, New York City Department of Health, Personal Communication, 2001~.
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From page 299... ...
However, staff shortages, a lack of expertise in cluster detection analysis, and difficulty in sustaining intensive scrutiny of data have made ongoing efforts difficult. Health departments that do not have electronically transferred data, requiring staff to collect and enter data in addition to coordinating follow-up, are struggling to maintain syndromic systems (Blythe, Maryland Department of Health and Mental Hygiene, Personal Communication, 2002; Sockwell, Virginia Department of Health (Northern Region)
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From page 300... ...
Other systems were designed as pilots to determine whether data can be efficiently transferred electronically and to address technical or security issues that might arise; outbreak detection and investigation are beyond the scope of these systems (Duchin, Public Health Seattle and King County, Personal Communication, 2002; Stanford Report, 2001; Weiss, Stanford University, Personal Communication, 2001; Chang, Hawaii Department of Health, Personal Communication, 2002~. ESSENCE and the emergency department triage log (chief complaint)
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From page 301... ...
Both health departments note that they would not have detected this increase with currently operating traditional surveillance systems, and both sites used the data to issue public health messages regarding ice-related injury prevention strategies (Sockwell, Virginia Department of Health (Norther Region) , Personal Communication, 2002; Barry, Boston Department of Health, Personal Communication, 2002~.
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From page 303... ...
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From page 306... ...
access now allow for much more rapid awareness of local disease outbreaks at distant points around the globe. Although there are few published reports of syndromic surveillance systems operating outside of the United States, efforts to enhance outbreak detection and link disease surveillance information have increased.
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From page 307... ...
2 participates in an Early Warning Outbreak Recognition System (EWORS) that collects real-time electronic syndromic data from selected hospital pediatric and internal medicine clinics and emergency departments in Indonesia (Corwin, 2000~.
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From page 308... ...
More research is needed to guide future planning before specific recommendations can be made. There are a number of potential benefits from syndromic surveillance: New opportunities for collaboration among health departments, emergency medical service providers, hospitals, information system managers, and commercial vendors An opportunity to reinforce the importance of identifying standardsbased vocabularies, messages, and case definitions to facilitate the use and transfer of data from clinical information systems to public health surveillance · Improved training for public health personnel in the area of information systems and disease-detection techniques · The potential to enhance notifiable disease and noninfectious disease reporting systems.
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From page 309... ...
CDC. Preventing Emerging Infectious Diseases: A strategy for the 21st century.
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From page 310... ...
Surveillance for unexplained deaths and critical illnesses due to possibly infectious causes, United States, 1995-1998. Emerg Infect Dis 2002;8:145-152.
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From page 311... ...
et al. An international outbreak of Vero cytotoxin-producing Escherichia cold 0157 infection amongst tourists: a challenge for the European infectious disease surveillance network.
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From page 312... ...
Slutsker L, Jarvis WR, Conn LA, Pinner RW. EMERGEncy ID NET: an emergency department-based emerging infections sentinel network.
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