Surveillance syndromic

One of the challenges for rapid outbreak detection is that patients with many of the illnesses described in previous chapters, especially infections, will present with ill-defmed syndromes or unexplained deaths (7). The first sign of a terrorist attack may 

By 2003, the New York City Health Department was monitoring more than 50,000 events daily, including 86% of all emergency department visits in New York City through coverage of 70% of all hospital emergency departments (9). 

Spatial data may present additional problems with accnracy. First, the only address available in a database may be home address, althongh the relevant expo-snre may have occurred elsewhere. Second, poor qnality of the address data may preclnde the accnrate identification of specific patient location. Third, the use of different scales of analysis, snch as censns tract, zip code, or metropolitan area can lead to different interpretations when analyzing the data (11). 

Administrative challenges pose a limitation to the completeness of any integrated system. Creating integrated systems that extend beyond the boundaries of a single health maintenance organization to area hospitals, emergency departments, and 

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There is a large reservoir of NoV in the commimity, as evidenced by surveys of community acquired and sporadic cases of gastroenteritis (Buesa et ah, 2002 Haustein et ah, 2009 Karsten et ah, 2009 Lindell et ah, 2005). Syndromic surveillance of vomiting reports also indicates that the presence of NoV infections is constantly fluctuating in different areas (Cooper et ah, 2008). This widespread reservoir means that NoVs are continually introduced into hospital settings where they can spread rapidly despite efforts to interrupt transmission (Cunliffe et al., 2010 Koopmans, 2009 Sommer et ah, 2009). Preventing the introduction of this widespread pathogen is nearly impossible (Koopmans, 2009 Yee et ah, 2007). 

Centers for Disease Control And Prevention, Syndromic Surveillance an Applied Approach to Outbreak Detection, June 6, 2005 available at www.cdc.gov / epo / dphsi / syndromic.htm. 

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... 

Case reports from physicians and other health care providers are a key data capture method in traditional public health surveillance and will continue to be an important data source in spite of less than optimal timeliness and completeness of such reporting (CDC, 2004b lOM NRC, 1999). At the same time, given the importance of early detection to the effectiveness of the response plan, additional surveillance approaches are being developed and tested that are designed to improve the timeliness and sensitivity of a biological event detection. Many of these new approaches are categorized as syndromic surveillance. 

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... 

A listing of CDC resources related to syndromic surveillance is available at http //www.cdc.gov/ epo/dphsi/syndromic.htm. 

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... 

How does syndromic surveillance differ from traditional notifiable disease surveillance ... 

Buehler, J. W. (2004). Review of the 2003 National Syndromic Surveillance Conference—Lessons learned and questions to be answered. In Syndromic surveillance, Reports from a national conference, 2003. Morbidity andMortality Weekly Report, S3(Suppl.), 18-22. 

Centers for Disease Control and Prevention. (2004a). Annotated bibliography for syndromic surveillance. Retrieved December 1, 2004, from http //www.cdc.gov/epo/dphsi/ syndromic/index.htm... 

Wagner, M. W, Espino, J., Tsui, F-C., Gesteiand, R, Chapman, W, Ivanov, 0. et al. (2004). Syndrome and outbreak detection using chief-complaint data—Experience of the Real-Time Outbreak and Disease Surveillance project. In Syndromic Surveillance Reports from a National Conference, 2003. Morbidity and Mortality Weekly Report, 53(Suppl.), 28-31. 

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. 

Buehler, J. W, Berkelman, R. L., Hartley, D. M., Peters, C. J. (2003). Syndromic surveillance and bioterrorism-related epidemics [Electronic version]. Emerging Infectious Diseases, 9, 1197-1204. 

Establish data collection protocols that systematically monitor community health indicators (e.g., aberrations in utilization trends or syndromic surveillance). 

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. 

New York City, Department of Health and Mental Hygiene. Key Agency Impact-2003, http // www.nyc.gov/html/doh/downloads/pdl/public/accomplish 2003.pdf, last accessed 3-12-06 Lazarus, R, Kleinman, KP, Dashevsky, 1, DeMaria, A, Platt, R. Using Automated Medical Records for the Rapid Identification of Illness Syndromes (Syndromic Surveillance) The Example of Lower Respiratory Infection. BMC Public Health, 2001. http //ww w.biomedcentral. com/1471-2458/1/9, last accessed 3-12-06... 

Mandl KD, Overhage JM, Wagner MM, et al. Implementing Syndromic Surveillance A Practical Guide Informed by the Early Experience. Journal of the American Medical Informatics Association, 11(2) 141-150, 2004... 

Lober, WB, Trigg, LJ, Karras, BT, Bliss, D, Cdiberti, J, Stewart, L, Duchin, JS. Syndromic Surveillance Using Automated Collection of Computerized Discharge Diagnoses. Journal or Urban Health, 80(2, Suppl. I) i97-il06, 2003... 

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