Real-time Outbreak And Disease Surveillance Research Articles

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.

Surveillance of Overdose-related Emergency Department Visits in Rhode Island

We determined if the Rhode Island Real-time Outbreak and Disease Surveillance (RODS) system identified an increase in emergency department (ED) overdose visits during a known cluster of illicit-drug overdose deaths in RI and characterized ED overdose visits. When stratified by ED there was a significant increase in overdose chief complaints from one ED during March - May 2013 compared to the previous year. This coincides with the cluster of drug overdose deaths in March 2013. Despite most chief complaints for overdose not specifying cause, syndromic surveillance systems provide an existing platform that could be used to better assess ED overdose visits.

Disease surveillance and nonprescription medication sales can predict increases in poison exposure

Real-time Outbreak and Disease Surveillance (RODS) is a national real-time syndromic surveillance system that classifies hospital registration chief complaints into one of seven syndromic categories. The National Retail Data Monitor (NRDM) is a public health surveillance tool that is designed to collect and analyze the daily sales of 18 categories of nonprescription medications. The goal of RODS and NRDM is to provide early warning of disease outbreaks, such as biological terrorism. The purpose of this study was to determine whether peak syndromic activity and the consequential purchase of nonprescription medications could predict an increase in poisoning exposures involving NRDM-monitored medications. Data from the RODS and NRDM databases were plotted graphically to portray activity that occurred during 2003. Data from a regional poison information center electronic medical record system that involved all human exposure calls related to NRDM monitored medications in 2003 were extracted and graphed. Analysis included comparisons between the data sets. Poison center exposure volume correlated predictably and simultaneously with the peak activity in both the RODS and NRDM databases. There was no delay between the onset of an influenza outbreak in December 2003, the sale of nonprescription palliative mediations, and the increase in poison center exposure call volume. Increased availability of and access to nonprescription medications resulted in more poisoning exposure calls. Real-time surveillance using other databases can help to forecast poison center activity. This knowledge allows the poison center to provide anticipatory guidance to the residents of its region.

Implementation of an automated, real-time public health surveillance system linking emergency departments and health units: rationale and methodology

In September 2004, Kingston, Frontenac, Lennox and Addington (KFL and A) Public Health, in collaboration with the Public Health Division of the Ontario Ministry of Health and Long-Term Care, Queen's University, the Public Health Agency of Canada, Kingston General Hospital and Hotel Dieu Hospital, began a 2-year pilot project to implement and evaluate an emergency department (ED) chief complaint syndromic surveillance system. Our objective was to evaluate a comprehensive and readily deployable real-time regional syndromic surveillance program and to determine its ability to detect gastrointestinal or respiratory outbreaks well in advance of traditional reporting systems. In order to implement the system, modifications were made to the University of Pittsburgh's Real-time Outbreak and Disease Surveillance (RODS) system, which has been successfully integrated into public health systems, and has enhanced communication and collaboration between them and EDs. This paper provides an overview of a RODS-based syndromic surveillance system as adapted for use at a public health unit in Kingston, Ontario. We summarize the technical specifications, privacy and security considerations, data capture, classification and management of the data streams, alerting and public health response. We hope that the modifications described here, including the addition of unique data streams, will provide a benchmark for future Canadian syndromic surveillance systems.

Establishing a nationwide emergency department-based syndromic surveillance system for better public health responses in Taiwan

BackgroundWith international concern over emerging infectious diseases (EID) and bioterrorist attacks, public health is being required to have early outbreak detection systems. A disease surveillance team was organized to establish a hospital emergency department-based syndromic surveillance system (ED-SSS) capable of automatically transmitting patient data electronically from the hospitals responsible for emergency care throughout the country to the Centers for Disease Control in Taiwan (Taiwan-CDC) starting March, 2004. This report describes the challenges and steps involved in developing ED-SSS and the timely information it provides to improve in public health decision-making.MethodsBetween June 2003 and March 2004, after comparing various surveillance systems used around the world and consulting with ED physicians, pediatricians and internal medicine physicians involved in infectious disease control, the Syndromic Surveillance Research Team in Taiwan worked with the Real-time Outbreak and Disease Surveillance (RODS) Laboratory at the University of Pittsburgh to create Taiwan's ED-SSS. The system was evaluated by analyzing daily electronic ED data received in real-time from the 189 hospitals participating in this system between April 1, 2004 and March 31, 2005.ResultsTaiwan's ED-SSS identified winter and summer spikes in two syndrome groups: influenza-like illnesses and respiratory syndrome illnesses, while total numbers of ED visits were significantly higher on weekends, national holidays and the days of Chinese lunar new year than weekdays (p < 0.001). It also identified increases in the upper, lower, and total gastrointestinal (GI) syndrome groups starting in November 2004 and two clear spikes in enterovirus-like infections coinciding with the two school semesters. Using ED-SSS for surveillance of influenza-like illnesses and enteroviruses-related infections has improved Taiwan's pandemic flu preparedness and disease control capabilities.ConclusionTaiwan's ED-SSS represents the first nationwide real-time syndromic surveillance system ever established in Asia. The experiences reported herein can encourage other countries to develop their own surveillance systems. The system can be adapted to other cultural and language environments for better global surveillance of infectious diseases and international collaboration.

Automated syndromic surveillance for the 2002 winter olympics

The 2002 Olympic Winter Games were held in Utah from February 8 to March 16, 2002. Following the terrorist attacks on September 11, 2001, and the anthrax release in October 2001, the need for bioterrorism surveillance during the Games was paramount. A team of informaticists and public health specialists from Utah and Pittsburgh implemented the Real-time Outbreak and Disease Surveillance (RODS) system in Utah for the Games in just seven weeks. The strategies and challenges of implementing such a system in such a short time are discussed. The motivation and cooperation inspired by the 2002 Olympic Winter Games were a powerful driver in overcoming the organizational issues. Over 114,000 acute care encounters were monitored between February 8 and March 31, 2002. No outbreaks of public health significance were detected. The system was implemented successfully and operational for the 2002 Olympic Winter Games and remains operational today.

Technical description of RODS: a real-time public health surveillance system

This report describes the design and implementation of the Real-time Outbreak and Disease Surveillance (RODS) system, a computer-based public health surveillance system for early detection of disease outbreaks. Hospitals send RODS data from clinical encounters over virtual private networks and leased lines using the Health Level 7 (HL7) message protocol. The data are sent in real time. RODS automatically classifies the registration chief complaint from the visit into one of seven syndrome categories using Bayesian classifiers. It stores the data in a relational database, aggregates the data for analysis using data warehousing techniques, applies univariate and multivariate statistical detection algorithms to the data, and alerts users of when the algorithms identify anomalous patterns in the syndrome counts. RODS also has a Web-based user interface that supports temporal and spatial analyses. RODS processes sales of over-the-counter health care products in a similar manner but receives such data in batch mode on a daily basis. RODS was used during the 2002 Winter Olympics and currently operates in two states—Pennsylvania and Utah. It has been and continues to be a resource for implementing, evaluating, and applying new methods of public health surveillance.