Surveillance systems syndromic

Stakeholders need to understand the advantages and limitations of syndromic surveillance systems. Syndromic surveillance systems might enhance collaboration among public health agencies, health-care providers, information-systems professionals, academic investigators, and industry. However, syndromic surveillance does not replace traditional public health surveillance, nor does it substitute for direct physician reporting of unusual or suspect cases of public health importance [33, 34],... 

This chapter provides a brief overview of systems currently in piace for the detection of biological events, either naturaiiy occurring disease outbreaks or deliberate bioterror events. Basic concepts related to infectious disease epidemiology and surveillance are presented. Different types of surveillance systems, including syndromic surveillance, are described. The roles of the... 

Syndromic surveillance refers to surveillance using health-related data that precede diagnosis and signal a sufficient probability of [a] case or an outbreak to warrant further public health response (CDC, 2004a, p. 1). Such surveillance occurs in real-time or near real-time to achieve what has been termed pre-emptive surveillance (Teich, Wagner, Mackenzie, Schafer, 2002, p. 6). The primary purpose of syndromic surveillance systems is earlier and more complete detection of outbreaks (CDC, 2004b), although systems to monitor other health... 

Syndromic surveillance systems have developed in tandem with advances in information technology. A major component of many syndromic systems is the use of available electronic databases to capture health indicator data. With such computerized data, automated search algorithms can he applied to detect unusual patterns that may signal an outbreak and can provide that signal earlier than is feasible using traditional surveillance methods (CDC, 2000 Lazarus et al., 2002 Polyak, Elbert, Pavlin, Kelley, 2002 Teich et al., 2002). 

Syndromic surveillance is a work in progress. There is a need for continued development of standardized signal detection methods and signal response protocols (Henning, 2004). Also, whereas reporting of patient information as part of traditional public health surveillance has been deemed exempt from the confidentiality guidelines in the Health Insurance Portability and Accountability Act of 1996 (HIPAA), how those guidelines may be applicable to syndromic surveillance systems remains unclear (Buehler, 2004). 

Whereas syndromic surveillance systems may enhance detection of outbreaks, the information generated is not of use unless it can be rapidly disseminated to the stakeholders responsible for implementing prevention... 

Community service organizations can play a direct role in providing specific health indicator data that would contribute to a syndromic surveillance system. Worksite absenteeism or patterns of health care behavior among clients are examples of potential indicators, but issues related to the confidentiality of such information under HIPAA have yet to be fully addressed. Even if no formal surveillance partnership to provide data exists, community service organizations should still consider themselves as stakeholders in the overall community response plans for biological events. They should also publicize the emergency public health contact information within their organizations. Table 20.3 lists several specific actions that community service... 

Public health surveillance is an essential process for detection of biological events. The traditional notifiable disease reporting system remains an important component of infectious diseases surveillance however, new approaches are being implemented that may enhance capabilities for early detection of events. The increasing availability of electronic health data and advances in information technologies provide opportunities for active, real-time surveillance systems (Teich et al., 2002). Syndromic surveillance systems that rely on alternative health indicators and detection of unusual patterns have... 

Recognition by routine surveillance systems (local, state, and federal) may be the first indicator of a bioterror event (Institute of Medicine [lOM] National Research Council, 1999). Background data on disease occurrence are needed so that an unusual pattern can be detected above the endemic (i.e., usual noise ) level. Current public health surveillance systems related to bioterrorism preparedness, including syndromic surveillance systems, are discussed in detail in chapter 20. 

By 1988 it was possible to summarize the adverse effects reported after the distribution of over 1.8 million doses of plasma-derived hepatitis B vaccine (Table 1) (2). From 1982 onwards, the Centers for Disease Control, the Food and Drug Administration, and the manufacturers, Merck Sharp Dohme, had supported a special surveillance system to monitor spontaneous reports of reactions to plasma-derived hepatitis vaccine. During the first 3 years, about 850 000 persons were immunized. In all, 41 reports were received for one of the following neurological adverse events convulsion (n = 5), Bell s palsy (n — 10), Guillain-Barre syndrome (n = 9), lumbar radiculopathy (n — 5), brachial plexus neuropathy (n = 3), optic neuritis (n — 5), and transverse myelitis (n = 4). Half of these events occurred after the first vaccine dose. However, no conclusive causal association could be made between any neurological adverse event and the vaccine (3). 

Patient confidentiality concerns may also limit the development of syndromic surveillance systems. Any automated reporting system will require confidentiality safeguards, such as the use of aggregated information (12). However, even with aggregated data, sorting by characteristics such as race, age, and zip code could still lead to identification of individuals. Therefore, surveillance systems will need standards restricting the display of aggregated data when numbers of events or population sizes are small (14). On the other hand, public health authorities may still need to be able to re-identify individuals to follow-up on cases (11). 

Given continued questions of timeliness, accuracy, confidentiality, and given the administrative hurdles facing development of complete, integrated syndromic surveillance systems, it is unlikely that automated syndromic surveillance systems will replace traditional clinician and laboratory initiated reporting systems within the next few years. Studies of the performance of syndromic surveillance systems are difficult due to the low frequency of large outbreaks of most diseases (11). Even if syndromic surveillance systems eventually demonstrate some utility, it is likely that they will complement, rather than replace, traditional clinician, and laboratory reporting. 

AAPCC-TESS American Association of Poison Control Centers-Toxic Exposure Surveillance System ALT Alanine aminotransferase ARDS Adult respiratory distress syndrome AST Aspartate aminotransferase BUN Blood urea nitrogen ECG Electrocardiogram INR International normalization ratio NAPQI A-acetyl-/>-benzoquinone-imine PPPA Poison Prevention Packaging Act (of 1970)... 

Specific definitions for syndromic surveillance are lacking, and the name itself is imprecise. Diverse names used to describe public health surveillance systems for early outbreak detection include ... 

Syndromic surveillance is simple and often the only available surveillance tool at the primary health care level when laboratory confirmation of disease is not possible [41], It allows detection of potential outbreaks of targeted diseases earlier than with the diagnosis-based routine surveillance system and leads to field investigations for confirmation and control [19, 20], Experience has shown that reporting units at the primary health care level are not the most appropriate source of notification for early detection of some epidemic-prone diseases. Some specific syndromes may be seen first in emergency departments, private clinics, or pharmacies [21],... 

Pavlin, J.A. 2003. Investigation of disease outbreaks detected by syndromic surveillance systems. J. Urban Health 80(Suppl l) i 107-114. 

Drug overdose Of 16 796 toxic exposures to antiepileptic drugs (phenytoin, valproic acid, and carbamazepine) in the USA in 2006, 12 resulted in death, as reported by the US Toxic Surveillance System [67 ]. Some specific problems determined by overdose of some old and new antiepileptic drugs have been briefly reviewed. For example, topiramate can cause a significant metabolic acidosis, lamotrigine Stevens-Johnson syndrome, oxcarbazepine hyponatremia, and levetiracetam psychosis. Possible adoption of guidelines for critical care management of overdose are discussed. 

Skin Discoloration of the leg after immunization is a relatively unknown entity, which has been studied during a 10-year period after immunization of infants in the Dutch National Vaccination Program [4 ]. Discolored leg syndrome was defined as an even or patchy red, blue, or purple discoloration of the leg(s) and/or petechiae with or without swelling. In all, 1162 reports of adverse events after immunization were made to the passive surveillance system between 1994 and 2003. Red, blue, or purple discoloration and isolated petechiae were reported in 39%, 19%, 27%, and 14% of these cases respectively 1105 cases were considered to be related to immunization, based on a predefined risk window with the onset of symptoms after immunization—48 hours for discoloration and 2 weeks for petechiae. Of the 1105 cases, about 50% occurred after DTP-IPV - -Hibl immunization, and 30% occurred after DTP-IPV + Hib2 immunization. Discolored leg syndrome was often accompanied by fierce crying (78%). The median interval between immunization and the occurrence of the syndrome was 3.8 hours... 

Heffernan, R., Mostashari, R, Das, D., Besculides, M., Rodriguez, C., Greenko, J., et al. (2004). New York City syndromic surveil-iance systems. In Syndromic surveillance Reports from a national conference, 2003. Morbidity andMortality Weekly Report, 53(SuppL), 25-27. 

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