International Society For Disease Surveillance Research Articles

Introductory Remarks from ISDS Annual Conference Scientific Program Chair

Colleagues,I am delighted to present to you the summary abstracts and presentations from the 2019 International Society of Disease Surveillance (ISDS) Conference which was held San Diego, CA from January 30th – February 2nd, 2019. Over the past several years, the concept of investing in data science and data scientists has been touted as a transformational endeavor for governmental organizations, non-profits, as well as private sector and commercial markets. How “true” data science is harnessed to influence and improve public health surveillance and population health remains to be seen. Data science has great potential to provide a new lens to inform and improve public health surveillance and population health. However, this lens needs to focus upon more than just “Big Data” analytics and information technology. It must also focus on fostering organizational environments and multi-agency collaborations that invigorate curiosity and experimentation and development of cross-disciplinarian partnerships to address multifactorial and multidimensional health and disparity challenges. It also must hone in on producing evidence-based analytic results to improve measurable health outcomes. Analysis and summary results are not the end products for surveillance. The concept of data science needs to be leveraged across public health to better communicate the findings of disease surveillance through the “storytelling of illness and disease” to influence public health policy, and ultimately improve population health.This year, with these ideas in mind, and with the support of a dynamic, engaged, and multi-disciplinary Scientific Planning Committee (SPC) - ISDS has expanded its conference scope beyond traditional tracks which historically focused on surveillance, informatics, and analysis, to include tracks related to:One HealthNon – Human Health SurveillanceEcologyCommunications, Medical Rhetoric, Visualization, and ReportingChronic Disease / Mental HealthSubstance AbuseData QualityInjury SurveillanceSubstance Abuse – Opioid SurveillanceRecognizing that Public Health is a collaborative and multi-disciplinary team sport, we have expanded our outreach efforts to include new partners across academia, the private sector, state, local, and tribal partners, as well as federal agencies. During the 2019 ISDS Conference, we had a significant increase in overall attendance (~375) and abstracts submissions compared to prior years; with 29 countries represented and 130 oral presentations and 95 poster presentations provided over the three-day conference. We held a number of sessions on Opioid Use and Prescribing Surveillance as well as Medical Rhetoric, Communications, and Visualization that were standing-room only and beyond.Our keynote speakers on the intersection of Data Science and Public Health included: William J. Kassler, MD, MPH, IBM Watson Health – Deputy Chief Health OfficerWilma J. Wooten, MD, MPH, Public Health Officer for the County of San DiegoMichael Hogarth, MD, FACP, FACMI, Chief Clinical Research Information Officer for University of California San Diego HealthSome of the key take-aways from the presentations at the 2019 ISDS Conference were that data science and the act of data collections and analysis are NOT the end goals of public health surveillance; they are just the beginning. Data do NOT speak for themselves; they require context, curation, interpretation, and ultimately need to effectively communicating findings through the story telling of illness and disease to officials, policy makers, and the public with the objective to inform and influence public health policy, motivate health behavior change, drive public health action, and ultimately improve population health.I encourage you to review the abstracts submitted here in the Online Journal of Public Health Informatics which were presented at the 2019 International Society for Disease Surveillance 2019 Conference and to engage multi-dimensional and multi-disciplinary conversations (reach out directly to authors and presenters) around these important topics, expand your networks and opportunities in the public health community. Regards,Peter Hicks, MA, MPHScientific Program Chair International Society for Disease Surveillance (ISDS) 2019Centers for Disease Control and Prevention**Information included in this statement are those of the author and do not represent the official position of the Centers for Disease Control and Prevention (CDC)

Harnessing Data Science Through Healthcare IT Interoperability

Harnessing Data Science Through Healthcare IT Interoperability

Forming Collaborations through the Data Quality Committee to Address Urgent Incidents

ObjectiveThe National Syndromic Surveillance Program (NSSP) Community of Practice (CoP) works to support syndromic surveillance by providing guidance and assistance to help resolve data issues and foster relationships between jurisdictions, stakeholders, and vendors. During this presentation, we will highlight the value of collaboration through the International Society for Disease Surveillance (ISDS) Data Quality Committee (DQC) between jurisdictional sites conducting syndromic surveillance, the Centers for Disease Control and Prevention’s (CDC) NSSP, and electronic health record (EHR) vendors when vendor-specific errors are identified, using a recent incident to illustrate and discuss how this collaboration can work to address suspected data anomalies.IntroductionOn November 20, 2017, several sites participating in the NSSP reported anomalies in their syndromic data. Upon review, it was found that between November 17-18, an EHR vendor’s syndromic product experienced an outage and errors in processing data. The ISDS DQC, NSSP, a large EHR vendor, and many of the affected sites worked together to identify the core issues, evaluate ramifications, and formulate solutions to provide to the entire NSSP CoP.DescriptionOn November 20, 2017, several sites participating in the NSSP reported anomalies in their syndromic data. Upon review, it was found that between November 17-18, an EHR vendor’s syndromic product experienced an outage and errors in processing data. The ISDS DQC, NSSP, a large EHR vendor, and many of the affected sites worked together to identify the core issues, evaluate ramifications, and formulate solutions to provide to the entire NSSP CoP.How the Moderator Intends to Engage the Audience in Discussions on the TopicFollowing presentation of this information, the presenters will lead a discussion on how to improve the response, provide resolution, communicate expectations, and decrease the time required to resolve issues should a similar event happen in the future. Participants from all three stakeholder groups, sites conducting syndromic surveillance, the NSSP, and vendor representatives, will be invited to share their experiences, successes, and concerns.

Using Syndromic Surveillance Data to Study the Impact of Media Content on Self-harm

Using Syndromic Surveillance Data to Study the Impact of Media Content on Self-harm

Precision public health through clinic-based syndromic surveillance in communities

ObjectiveSentinel physician surveillance in the communities has played an important role in detecting early aberrations in epidemics. The traditional approach is to ask primary care physicians to actively report some diseases such as influenza-like illness (ILI), and hand, foot, and mouth disease (HFMD) to health authorities on a weekly basis. However, this is labor-intensive and time-consuming work. In this study, we try to set up an automatic sentinel surveillance system to detect 23 syndromic groups in the communites.IntroductionIn December 2009, Taiwan’s CDC stopped its sentinel physician surveillance system. Currently, infectious disease surveillance systems in Taiwan rely on not only the national notifiable disease surveillance system but also real-time outbreak and disease surveillance (RODS) from emergency rooms, and the outpatient and hospitalization surveillance system from National Health Insurance data. However, the timeliness of data exchange and the number of monitored syndromic groups are limited. The spatial resolution of monitoring units is also too coarse, at the city level. Those systems can capture the epidemic situation at the nationwide level, but have difficulty reflecting the real epidemic situation in communities in a timely manner. Based on past epidemic experience, daily and small area surveillance can detect early aberrations. In addition, emerging infectious diseases do not have typical symptoms at the early stage of an epidemic. Traditional disease-based reporting systems cannot capture this kind of signal. Therefore, we have set up a clinic-based surveillance system to monitor 23 kinds of syndromic groups. Through longitudinal surveillance and sensitive statistical models, the system can automatically remind medical practitioners of the epidemic situation of different syndromic groups, and will help them remain vigilant to susceptible patients. Local health departments can take action based on aberrations to prevent an epidemic from getting worse and to reduce the severity of the infected cases.MethodsWe collected data on 23 syndromic groups from participating clinics in Taipei City (in northern Taiwan) and Kaohsiung City (in southern Taiwan). The definitions of 21 of those syndromic groups with ICD-10 diagnoses were adopted from the International Society for Disease Surveillance (https://www.surveillancerepository.org/icd-10-cm-master-mapping-reference-table). The definitions of the other two syndromic groups, including dengue-like illness and enterovirus-like illness, were suggested by infectious disease and emergency medicine specialists.An enhanced sentinel surveillance system named “Sentinel plus” was designed for sentinel clinics and community hospitals. The system was designed with an interactive interface and statistical models for aberration detection. The data will be computed for different combinations of syndromic groups, age groups and gender groups. Every day, each participating clinic will automatically upload the data to the provider of the health information system (HIS) and then the data will be transferred to the research team.This study was approved by the committee of the Institutional Review Board (IRB) at Academia Sinica (AS-IRB02-106262, and AS-IRB02-107139). The databases we used were all stripped of identifying information and thus informed consent of participants was not required.ResultsThis system started to recruit the clinics in May 2018. As of August 2018, there are 89 clinics in Kaohsiung City and 33 clinics and seven community hospitals in Taipei City participating in Sentinel plus. The recruiting process is still ongoing. On average, the monitored volumes of outpatient visits in Kaohsiung City and Taipei City are 5,000 and 14,000 per day.Each clinic is provided one list informing them of the relative importance of syndromic groups, the age distribution of each syndromic group and a time-series chart of outpatient rates at their own clinic. In addition, they can also view the village-level risk map, with different alert colors. In this way, medical practitioners can know what’s going on, not only in their own clinics and communities but also in the surrounding communities.The Department of Health (Figure 1) can know the current increasing and decreasing trends of 23 syndromic groups by red and blue color, respectively. The spatial resolution has four levels including city, township, village and clinic. The map and bar chart represent the difference in outpatient rate between yesterday and the average for the past week. The line chart represents the daily outpatient rates for one selected syndromic group in the past seven days. The age distribution of each syndromic group and age-specific outpatient rates in different syndromic groups can be examined.ConclusionsSentinel plus is still at the early stage of development. The timeliness and the accuracy of the system will be evaluated by comparing with some syndromic groups in emergency rooms and the national notifiable disease surveillance system. The system is designed to assist with surveillance of not only infectious diseases but also some chronic diseases such as asthma. Integrating with external environmental data, Sentinel plus can alert public health workers to implement better intervention for the right population.

Monitoring suicide-related events using National Syndromic Surveillance Program data

ObjectiveTo describe epidemiological characteristics of emergency department (ED) visits related to suicidal ideation (SI) or suicidal attempt (SA) using syndromic surveillance data.IntroductionSuicide is a growing public health problem in the United States.1 From 2001 to 2016, ED visit rates for nonfatal self-harm, a common risk factor for suicide, increased 42%.2–4 To improve public health surveillance of suicide-related problems, including SI and SA, the Data and Surveillance Task Force within the National Action Alliance for Suicide Prevention recommended the use of real-time data from hospital ED visits.5 The collection and use of real-time ED visit data on SI and SA could support a more targeted and timely public health response to prevent suicide.5 Therefore, this investigation aimed to monitor ED visits for SI or SA and to identify temporal, demographic, and geographic patterns using data from CDC’s National Syndromic Surveillance Program (NSSP).MethodsCDC’s NSSP data were used to monitor ED visits related to SI or SA among individuals aged 10 years and older from January 1, 2016 through July 31, 2018. A syndrome definition for SI or SA, developed by the International Society for Disease Surveillance’s syndrome definition committee in collaboration with CDC, was used to assess SI or SA-related ED visits. The syndrome definition was based on querying the chief complaint history, discharge diagnosis, and admission reason code and description fields for a combination of symptoms and Boolean operators (for example, hang, laceration, or overdose), as well as ICD-9-CM, ICD-10-CM, and SNOMED diagnostic codes associated with SI or SA. The definition was also developed to include common misspellings of self-harm-related terms and to exclude ED visits in which a patient “denied SI or SA.”The percentage of ED visits involving SI or SA were analyzed by month and stratified by sex, age group, and U.S. region. This was calculated by dividing the number of SI or SA-related ED visits by the total number of ED visits in each month. The average monthly percentage change of SI or SA overall and for each U.S. region was also calculated using the Joinpoint regression software (Surveillance Research Program, National Cancer Institute).6ResultsAmong approximately 259 million ED visits assessed in NSSP from January 2016 to July 2018, a total of 2,301,215 SI or SA-related visits were identified. Over this period, males accounted for 51.2% of ED visits related to SI or SA, and approximately 42.1% of SI or SA-related visits were comprised of patients who were 20-39 years, followed by 40-59 years (29.7%), 10-19 years (20.5%), and ≥60 years (7.7%).During this period, the average monthly percentage of ED visits involving SI or SA significantly increased 1.1%. As shown in Figure 1, all U.S. regions, except for the Southwest region, experienced significant increases in SI or SA ED visits from January 2016 to July 2018. The average monthly increase of SI or SA-related ED visits was 1.9% for the Midwest, 1.5% for the West (1.5%), 1.1% for the Northeast, 0.9% for the Southeast, and 0.5% for the Southwest.ConclusionsED visits for SI or SA increased from January 2016 to June 2018 and varied by U.S. region. In contrast to previous findings reporting data from the National Electronic Injury Surveillance Program – All-Injury Program, we observed different trends in SI or SA by sex, where more ED visits were comprised of patients who were male in our investigation.2 Syndromic surveillance data can fill an existing gap in the national surveillance of suicide-related problems by providing close to real-time information on SI or SA-related ED visits.5 However, our investigation is subject to some limitations. NSSP data is not nationally representative and therefore, these findings are not generalizable to areas not participating in NSSP. The syndrome definition may under-or over-estimate SI or SA based on coding differences and differences in chief complaint or discharge diagnosis data between jurisdictions. Finally, hospital participation in NSSP can vary across months, which could potentially contribute to trends observed in NSSP data. Despite these limitations, states and communities could use this type of surveillance data to detect abnormal patterns at more detailed geographic levels and facilitate rapid response efforts. States and communities can also use resources such as CDC’s Preventing Suicide: A Technical Package of Policy, Programs, and Practices to guide prevention decision-making and implement comprehensive suicide prevention approaches based on the best available evidence.7

Cross Disciplinary Consultancy to Bridge Public Health Technical Needs and Analytic Developers: Negation Detection Use Case.

This paper describes a continuing initiative of the International Society for Disease Surveillance designed to bring together public health practitioners and analytics solution developers from both academia and industry. Funded by the Defense Threat Reduction Agency, a series of consultancies have been conducted on a range of topics of pressing concern to public health (e.g. developing methods to enhance prediction of asthma exacerbation, developing tools for asyndromic surveillance from chief complaints). The topic of this final consultancy, conducted at the University of Utah in January 2017, is focused on defining a roadmap for the development of algorithms, tools, and datasets for improving the capabilities of text processing algorithms to identify negated terms (i.e. negation detection) in free-text chief complaints and triage reports.

Justification for Collecting Urgent Care Data to Broaden Syndromic Surveillance

Objective: Provide justification for the collection and reporting of urgent care (UC) data for public health syndromic surveillance.Introduction: While UC does not have a standard definition, it can generally be described as the delivery of ambulatory medical care outside of a hospital emergency department (ED) on a walk-in basis, without a scheduled appointment, available at extended hours, and providing an array of services comparable to typical primary care offices.1 UC facilities represent a growing sector of the United States healthcare industry, doubling in size between 2008 and 2011.1 The Urgent Care Association of America (UCAOA) estimates that UC facilities had 160 million patient encounters in 2013.2 This compares to 130.4 million patient encounters in EDs in 2013, as reported by the National Hospital Ambulatory Medical Care Survey.3 Public Health (PH) is actively working to broaden syndromic surveillance to include urgent care data as more individuals use these services.4 PH needs justification when reaching out to healthcare partners to get buy-in for collecting and reporting UC data.Description: The International Society for Disease Surveillance (ISDS) Community of Practice (CoP) platform was used to host a webinar introducing the topic of urgent care participation in syndromic surveillance. This webinar provided a valuable opportunity to obtain insight from jurisdictions pursuing and using UC data. A workgroup was formed to create documentation justifying the collection and reporting of UC data. Using this forum, the workgroup brought together partners from various jurisdictions working with UC data to participate in a literature review of SCOPUS, PubMed, and the Online Journal of Public Health Informatics publications and to share their experiences. These two main sources of information – previous literature and jurisdictional experience – were combined and condensed to provide tangible justifications for the collection and use of UC data.While the workgroup found little in the literature to justify the collection of UC data as a part of syndromic surveillance, the shared experiences of the CoP jurisdictions working to onboard UC facilities provided valuable insight. From this collaborative response, three main reasons to collect UC data were identified.1) Healthcare reform is directing patients away from EDs and toward UC facilities. UC represents reduced cost and more efficient patient processing, thus easing the burden on both patient and healthcare system (according to a 2016 American Academy of Pediatrics article entitled “Urgent Care and Emergency Department Visits in the Pediatric Medicaid Population”). If syndromic surveillance does not adapt to include UC data, the potential exists to lose significant patient populations, which may lead to decreased situational awareness.2) According to the Centers for Medicare and Medicaid Services Stage 3 guidance, Meaningful Use (MU) will change the relationship between eligible professionals (EPs) and syndromic surveillance by restricting EPs to those who practice in a UC facility. This approach to EP participation simplifies the syndromic surveillance MU objective, thereby making it easier for PH jurisdictions to onboard UC facilities.3) Patients with certain conditions that are acute but non-emergent may report more frequently to an UC facility than to an ED. Broadening syndromic surveillance to include UC facilities may increase reporting of “rare event” encounters, which will lower the relative standard error for statistical calculation. Surveillance efforts for conditions like influenza-like illness and Zika virus may improve substantially with a larger data pool.How the Moderator Intends to Engage the Audience in Discussions on the Topic: The moderator will begin discussion with a brief presentation from the literature review and jurisdictional experience, highlighting three justifications for collecting and reporting UC data. The audience will be divided into 3 groups to discuss and validate 3 additional topics: creation of syndromic surveillance talking points to share with UC facility management, creation of jurisdictional UC facility listings, and UC onboarding best practices. Feedback from the 3 groups will be shared with the whole group, followed by a brief summary of the discussion and recommendations for next steps.

Evaluation of an arboviral syndrome query used in Maricopa County, Arizona

ObjectiveTo evaluate Arizona’s arboviral syndromic surveillance protocol in Maricopa County.IntroductionTimely identification of arboviral disease is key to prevent transmission in the community, but traditional surveillance may take up to 14 days between specimen collection and health department notification. Arizona state and county health agencies began monitoring National Syndromic Surveillance Program BioSense 2.0 data for patients infected with West Nile virus (WNV), St. Louis encephalitis virus (SLEV), chikungunya, or dengue virus in August 2015. Zika virus was added in April 2016. Our novel methods were presented at the International Society for Disease Surveillance 2015 Annual Conference. [1] Twice per week, we queried patient records from 15 Maricopa County BioSense-enrolled emergency department and inpatient hospitals for chief complaint keywords and discharge diagnosis codes. Our “Case Investigation Decision Tree” helped us determine whether records had a high or low degree of evidence for arboviral disease and necessitated further investigation. This study evaluated how Arizona’s protocol for conducting syndromic surveillance compared to traditional arboviral surveillance in terms of accuracy and timeliness in Maricopa County from August 2015 through December 2016.MethodsWe followed guidelines from the Centers for Disease Control and Prevention (CDC) to evaluate two major attributes of the protocol: accuracy [measured as positive predictive value (PPV) and sensitivity] and timeliness. [2] Arizona’s Medical Electronic Disease Surveillance Intelligence System (MEDSIS) was considered the “gold standard” system and BioSense was the test system. PPV was calculated as the proportion of records identified by BioSense that were reported to MEDSIS, regardless of final case classification. Sensitivity was the proportion of confirmed or probable cases in MEDSIS identified by BioSense. Though not all MEDSIS cases were seen at BioSense-reporting facilities, the sensitivity demonstrates how each query contributed to arboviral surveillance overall. We assessed timeliness in two ways: (1) the difference between the date when keywords or diagnosis codes were first identified by BioSense and the date the same patient was first reported to MEDSIS; and (2) the difference between the date the BioSense record was first reviewed by the Maricopa County Department of Public Health (MCDPH) syndromic surveillance team and the date the same patient was first investigated through MEDSIS by the MCDPH disease investigators. We assessed whether timeliness was affected by the method in which a record was identified in BioSense (i.e., chief complaint keyword or discharge diagnosis code).ResultsThe arboviral syndromic surveillance queries identified 62 records during the evaluation period (Table). For each arboviral query, the proportion of BioSense records that were also reported through MEDSIS ranged from 25.0% to 32.4%, except chikungunya, which had a PPV of 0%. BioSense records that had a high degree of evidence for arboviral disease tended to have a higher PPV compared to those with low evidence. BioSense records that were not already reported to MEDSIS met neither clinical nor exposure criteria for the arboviral diseases and were not deemed a public health risk. The sensitivities of the WNV and Zika queries to detect confirmed or probable cases in MEDSIS were 8.2% and 5.6%, respectively, while SLEV, chikungunya, and dengue queries were 0%. On average, patients were reported to MEDSIS 7 days prior to BioSense identifying keywords or diagnosis codes. In addition, MEDSIS cases were investigated by MCDPH disease investigators 10 days prior to MCDPH syndromic surveillance team review of BioSense records, on average. The average time between MEDSIS report date and BioSense identification date was shorter for BioSense records identified by chief complaint keywords than by diagnosis codes (4 and 8 days after MEDSIS, respectively).ConclusionsArizona’s arboviral syndromic surveillance protocol provided MCDPH with situational awareness, but BioSense data were not available more quickly than traditional mandated reporting. Through this process, we reviewed patient records that mentioned arboviral diseases and confirmed that these reportable conditions were captured in our traditional surveillance system. The decision tree was effective at prioritizing records for further investigation. Timeliness may be improved by updating the queries to include more chief complaint keywords and reviewing BioSense more than twice per week. MCDPH plans to evaluate Arizona’s updated arboviral syndromic surveillance protocol, which was adapted for BioSense Platform’s Electronic Surveillance System for Early Notification of Community-based Epidemics (ESSENCE).

Lessons learnt from implementation of the International Health Regulations: a systematic review.

ObjectiveTo respond to the World Health Assembly call for dissemination of lessons learnt from countries that have begun implementing the International Health Regulations, 2005 revision; IHR (2005).MethodsIn November 2015, we conducted a systematic search of the following online databases and sources: PubMed®, Embase®, Global Health, Scopus, World Health Organization (WHO) Global Index Medicus, WHO Bulletin on IHR Implementation and the International Society for Disease Surveillance. We included identified studies and reports summarizing national experience in implementing any of the IHR (2005) core capacities or their components. We excluded studies that were theoretical or referred to IHR (1969). Qualitative systematic review methodology, including meta-ethnography, was used for qualitative synthesis.FindingsWe analysed 51 articles from 77 countries representing all WHO Regions. The meta-syntheses identified a total of 44 lessons learnt across the eight core capacities of IHR (2005). Major themes included the need to mobilize and sustain political commitment; to adapt global requirements based on local sociocultural, epidemiological, health system and economic contexts; and to conduct baseline and follow-up assessments to monitor the status of IHR (2005) implementation.ConclusionAlthough experiences of IHR (2005) implementation covered a wide global range, more documentation from Africa and Eastern Europe is needed. We did not find specific areas of weakness in monitoring IHR (2005); sustained monitoring of all core capacities is required to ensure effective systems. These lessons learnt could be adapted by countries in the process of meeting IHR (2005) requirements.

A Practitioner-Driven Research Agenda for Syndromic Surveillance.

Syndromic surveillance has expanded since 2001 in both scope and geographic reach and has benefited from research studies adapted from numerous disciplines. The practice of syndromic surveillance continues to evolve rapidly. The International Society for Disease Surveillance solicited input from its global surveillance network on key research questions, with the goal of improving syndromic surveillance practice. A workgroup of syndromic surveillance subject matter experts was convened from February to June 2016 to review and categorize the proposed topics. The workgroup identified 12 topic areas in 4 syndromic surveillance categories: informatics, analytics, systems research, and communications. This article details the context of each topic and its implications for public health. This research agenda can help catalyze the research that public health practitioners identified as most important.

2016 International Society for Disease Surveillance Conference New Frontiers in Surveillance: Data Science and Health Security

The International Society for Disease Surveillance (ISDS) held itsfifteenth annual conference in Atlanta, GA, from December 6-8, 2016.Since 2001, individuals interested in sharing and learning emergingtrends in surveillance research and practice have found the ISDSAnnual Conference a unique forum to advance their knowledge in thediscipline of disease surveillance. The 15th ISDS conference receiveda total of 233 abstracts from 23 countries. From the submissions, 189(81%) were accepted for presentation at the conference as an oralpresentation (N=96) or poster (N=93).The theme for the 15th annual conference was New Frontiers inSurveillance: Data Science and Health Security. The theme unitedtwo dominant trends in public health surveillance: 1) a growing desireto extract knowledge from increasing volumes of structured andunstructured data available from health information systems; and 2)increased pressure on nations to strengthen their capacity for diseasesurveillance and response to outbreaks when and where they occuracross the globe. In addition to the major themes of the conference,abstracts were accepted in additional tracks that remain important tothe practice of public health around the world: One Health unitinganimal and human health; Methodological advances in appliedepidemiology; Public health informatics; Public health policy; andBiosurveillance practice.As usual, accepted abstracts for the 2016 ISDS Conferencespan the breadth of surveillance practice around the globe. Thereare timely abstracts on the detection and response to vector-bornediseases such as Zika virus and chikungunya across the Americas,as well as abstracts on the surveillance of opioid abuse observedin many parts of the U.S. Other abstracts cover the surveillance ofnon-communicable diseases that are now the leading causes of deathglobally. Additionally, some abstracts focus on capacity buildingwithin low resource settings on multiple continents to enhance globalhealth security. While other abstracts describe the impact of healthinformation technology (or eHealth) policies on surveillance practiceat local, national, or regional levels. And still other abstracts containemerging, novel methods that advance our understanding of howto analyze “Big” data or reduce the messiness associated with realworldsurveillance data. Together these abstracts represent the broad,diverse and interesting nature of surveillance practice. Furthermore,the abstracts represent important work being done in high incomecountries like the U.S., Canada and the U.K. as well as critical workbeing done in low-and-middle income nations such as Nigeria,Pakistan, and Sierra Leone.I wish to thank the dedicated members of the Scientific ProgrammingCommittee (SPC) and ISDS staff who helped to manage the process ofselecting this year’s abstracts for presentation. These individuals aredomain experts across the spectrum of tracks and themes representedin the program, and their service is much appreciated. The SPC helpedto recruit dozens of public health researchers and practitioners whoalso spent time reviewing abstracts. I also thank these volunteersfor contributing to the richness and diversity of this year’s program.Finally, I wish to thank the Track Chairs who reviewed abstracts andrecruited peers to perform reviews, and whom helped me organizepresentations into meaningful sessions for the final conferenceprogram. Their names are listed in the proceedings to recognize theirselfless service to ISDS and the field of public health surveillance.I hope that these proceedings help to advance scientificunderstanding and the practice of surveillance in public health. Pleaseuse the knowledge herein to improve how you practice or evaluatesurveillance in your jurisdiction. Or you may find ways to apply theknowledge elsewhere in population health. However you use it, I askthat you document your lessons or findings and submit to ISDS inthe future to share the outcomes with others. Together we can reducethe burden of disease and improve health outcomes for populationsglobally.

A practitioner-driven research agenda for syndromic surveillance

ObjectiveTo obtain feedback and seek future directions for an ISDS initiativeto establish and update research questions in Informatics, Analytics,Communications, and Systems Research with the greatest perceivedimpact for improving surveillance practice.IntroductionOver the past fifteen years, syndromic surveillance (SyS) hasevolved from a set ofad hocmethods used mostly in post-disastersettings, then expanded with broad support and development becauseof bioterrorism concerns, and subsequently evolved to a maturetechnology that runs continuously to detect and monitor a widerange of health issues. Continued enhancements needed to meetthe challenges of novel health threats with increasingly complexinformation sources will require technical advances focused onday-to-day public health needs.Since its formation in 2005, the International Society for DiseaseSurveillance (ISDS) has sought to clarify and coordinate globalpriorities in surveillance research. As part of a practitioner-driveninitiative to identify current research priorities in SyS, ISDS polledits members about capabilities needed by SyS practitioners that couldbe improved as a result of research efforts. A taskforce of the ISDSResearch Committee, consisting of national and global subject matterexperts (SMEs) in SyS and ISDS professional staff, carried out theproject. This panel will discuss the results and the preferred means todetermine and communicate priorities in the future.

Key elements of infectious disease syndromic surveillance systems: A scoping review

IntroductionSyndromic surveillance is an alternative type of public healthsurveillance which utilises pre-diagnostic data sources to detectoutbreaks earlier than conventional (laboratory) surveillance andmonitor the progression of illnesses in populations. These systems areoften noted for their ability to detect a wider range of cases in under-reported illnesses, utilise existing data sources, and alert public healthauthorities of emerging crises. In addition, they are highly versatileand can be applied to a wide range of illnesses (communicable andnon-communicable) and environmental conditions. As a result, theirimplementation in public health practice is expanding rapidly. Thisscoping review aimed to identify all existing literature detailing thenecessary components in the defining, creating, implementing, andevaluating stages of human infectious disease syndromic surveillancesystems.MethodsA full scoping review protocol was developeda priori. Theresearch question posed for the review was “What are the essentialelements of a fully functional syndromic surveillance system forhuman infectious disease?” Five bibliographic databases (Pubmed,Scopus, CINAHL, Web of Science, ProQuest) and eleven websites(Google, Public Health Ontario, Public Health England, Public HealthAgency of Canada, Centers for Disease Control and Prevention,European Centre for Disease Prevention and Control, InternationalSociety for Disease Surveillance, Syndromic Surveillance Systems inEurope, Eurosurveillance, Kingston Frontenac, Lennox & AddingtonPublic Health (x2)) were searched for peer-reviewed, government,academic, conference, and book literature. A total of 1237 uniquecitations were identified from this search and uploaded into thescoping review softwareCovidence. The titles and abstracts werescreened for relevance to the subject material, resulting in 142documents for full-text screening. Following this step, 55 documentsremained for data extraction and inclusion in the scoping review. Twoindependent reviewers conducted each step.ResultsThe scoping review identified many essential elements in thedefining, creating, implementing, and evaluating of syndromicsurveillance systems. These included the defining of “syndromicsurveillance”, classification of syndromes, data quality andcompleteness, statistical methods, privacy and confidentialityissues, costs, operational challenges, management composition,collaboration with other public health agencies, and evaluationcriteria. Several benefits and limitations of the systems were alsoidentified, when comparing them to other public health surveillancemethods. Benefits included the timeliness of analyses and reporting,potential cost savings, complementing traditional surveillancemethods, high sensitivity, versatility, ability to perform short- andlong-term surveillance, non-specificity of the systems, ability to fillin gaps of under-reported illnesses, and the collaborations whichare fostered through its platform; limitations included the potentialresources and costs required, inability to replace traditional healthcareand surveillance methods, the false alerts which may occur, non-specificity of the systems, poor data quality and completeness, timelags in analyses, limited effectiveness at detecting smaller-scaleoutbreaks, and privacy issues with accessing data.ConclusionsOver the past decade, syndromic surveillance systems have becomean integral part of public health practice internationally. Their abilityto monitor a wide variety of illnesses and conditions, detect illnessesearlier than traditional surveillance methods, and be created usingexisting data sources make them a valuable public health tool.The results from this scoping review demonstrate the benefits andlimitations and overall role of the systems in public health practice.In addition, this study also shows that a complete set of key elementsare required in order to properly define, create, implement, andevaluate these systems to ensure their effectiveness and performance.

Cross-Disciplinary Consultancy to Enhance Predictions of Asthma Exacerbation Risk in Boston

This paper continues an initiative conducted by the International Society for Disease Surveillance with funding from the Defense Threat Reduction Agency to connect near-term analytical needs of public health practice with technical expertise from the global research community. The goal is to enhance investigation capabilities of day-to-day population health monitors. A prior paper described the formation of consultancies for requirements analysis and dialogue regarding costs and benefits of sustainable analytic tools. Each funded consultancy targets a use case of near-term concern to practitioners. The consultancy featured here focused on improving predictions of asthma exacerbation risk in demographic and geographic subdivisions of the city of Boston, Massachusetts, USA based on the combination of known risk factors for which evidence is routinely available. A cross-disciplinary group of 28 stakeholders attended the consultancy on March 30-31, 2016 at the Boston Public Health Commission.Known asthma exacerbation risk factors are upper respiratory virus transmission, particularly in school-age children, harsh or extreme weather conditions, and poor air quality. Meteorological subject matter experts described availability and usage of data sources representing these risk factors. Modelers presented multiple analytic approaches including mechanistic models, machine learning approaches, simulation techniques, and hybrids. Health department staff and local partners discussed surveillance operations, constraints, and operational system requirements. Attendees valued the direct exchange of information among public health practitioners, system designers, and modelers. Discussion finalized design of an 8-year de-identified dataset of Boston ED patient records for modeling partners who sign a standard data use agreement.

New Master Mapping Reference Table (MMRT) to Assist ICD-10 Transition for Syndromic Surveillance

The International Society for Disease Surveillance (ISDS), in consultation with the CDC and the Council of State and Territorial Epidemiologists (CSTE), conducted a project to develop consensus-driven syndrome definitions based on ICD-10-CM codes. The goal was to have the newly created ICD-9-CM-to-ICD-10-CM mappings and corresponding syndromic definitions fully reviewed and vetted by the syndromic surveillance community, which relies on these codes for routine surveillance as well as for research purposes. The resulting tool, the Master Mapping Reference Table, may be leveraged by other federal, state, and local public health entities to better prepare and improve their surveillance, analytics, and reporting activities impacted by the ICD-10-CM transition.

Cross-Disciplinary Consultancy to Bridge Public Health Technical Needs and Analytic Developers: Asyndromic Surveillance Use Case.

Introduction: We document a funded effort to bridge the gap between constrained scientific challenges of public health surveillance and methodologies from academia and industry. Component tasks are the collection of epidemiologists’ use case problems, multidisciplinary consultancies to refine them, and dissemination of problem requirements and shareable datasets. We describe an initial use case and consultancy as a concrete example and challenge to developers.Materials and Methods: Supported by the Defense Threat Reduction Agency Biosurveillance Ecosystem project, the International Society for Disease Surveillance formed an advisory group to select tractable use case problems and convene inter-disciplinary consultancies to translate analytic needs into well-defined problems and to promote development of applicable solution methods. The initial consultancy’s focus was a problem originated by the North Carolina Department of Health and its NC DETECT surveillance system: Derive a method for detection of patient record clusters worthy of follow-up based on free-text chief complaints and without syndromic classification.Results: Direct communication between public health problem owners and analytic developers was informative to both groups and constructive for the solution development process. The consultancy achieved refinement of the asyndromic detection challenge and of solution requirements. Participants summarized and evaluated solution approaches and discussed dissemination and collaboration strategies.Practice Implications: A solution meeting the specification of the use case described above could improve human monitoring efficiency with expedited warning of events requiring follow-up, including otherwise overlooked events with no syndromic indicators. This approach can remove obstacles to collaboration with efficient, minimal data-sharing and without costly overhead.

Using Social Media for Actionable Disease Surveillance and Outbreak Management: A Systematic Literature Review.

ObjectiveResearch studies show that social media may be valuable tools in the disease surveillance toolkit used for improving public health professionals’ ability to detect disease outbreaks faster than traditional methods and to enhance outbreak response. A social media work group, consisting of surveillance practitioners, academic researchers, and other subject matter experts convened by the International Society for Disease Surveillance, conducted a systematic primary literature review using the PRISMA framework to identify research, published through February 2013, answering either of the following questions:Can social media be integrated into disease surveillance practice and outbreak management to support and improve public health?Can social media be used to effectively target populations, specifically vulnerable populations, to test an intervention and interact with a community to improve health outcomes?Examples of social media included are Facebook, MySpace, microblogs (e.g., Twitter), blogs, and discussion forums. For Question 1, 33 manuscripts were identified, starting in 2009 with topics on Influenza-like Illnesses (n = 15), Infectious Diseases (n = 6), Non-infectious Diseases (n = 4), Medication and Vaccines (n = 3), and Other (n = 5). For Question 2, 32 manuscripts were identified, the first in 2000 with topics on Health Risk Behaviors (n = 10), Infectious Diseases (n = 3), Non-infectious Diseases (n = 9), and Other (n = 10).ConclusionsThe literature on the use of social media to support public health practice has identified many gaps and biases in current knowledge. Despite the potential for success identified in exploratory studies, there are limited studies on interventions and little use of social media in practice. However, information gleaned from the articles demonstrates the effectiveness of social media in supporting and improving public health and in identifying target populations for intervention. A primary recommendation resulting from the review is to identify opportunities that enable public health professionals to integrate social media analytics into disease surveillance and outbreak management practice.

2014 International Society for Disease Surveillance Conference Translating Research and Surveillance into Action

Editorial

How Should We Be Conducting Routine Analysis of Traditional Emergency Department Syndromic Surveillance Data?

This roundtable will focus on how traditional emergency department syndromic surveillance systems should be used to conduct daily or periodic disease surveillance. As outbreak detection using these systems has demonstrated an equivocal track record, epidemiologists have sought out other interesting uses for these systems. Over the numerous years of the International Society for Disease Surveillance (ISDS) Conference, many of these studies have been presented; however, there has been a dearth of discussion related to how these systems should be used. This roundtable offers a forum to discuss best practices for the routine use of emergency department syndromic surveillance data.