scholarly journals Outbreak of ED visits related to the use of synthetic cannabinoids, Mayotte Island

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Pascal Vilain ◽  
Salamta Bah-Assoumani ◽  
Ali-Mohamed Youssouf ◽  
Laurent Filleul
Keyword(s):  
Public Health ◽  
Behavioral Disorders ◽  
Surveillance System ◽  
Syndromic Surveillance ◽  
Adverse Reactions ◽  
Health Agency ◽  
Case Definition ◽  
Syndromic Surveillance System ◽  
Ed Visits ◽  
Mental And Behavioral Disorders

ObjectiveTo confirm and to characterize the increase in emergency department (ED) visits related to the use of synthetic cannabinoids (SC)IntroductionOn October 2016, the Indian Ocean Regional Health Agency was alerted about an increase in ED visits related to adverse reactions associated with use of SC on Mayotte Island. In this context, an investigation based on a syndromic surveillance system was implemented by the regional unit of the French national public health agency.MethodsAn extraction of anonymized records routinely collected by the syndromic surveillance system (1) was carried out from January 1st, 2012 to October 30, 2016. ED visits related to the consumption of SC were identified from ICD-10 codes of the principal diagnostic according to two levels of confidence:- a probable case was defined as ED visit coded X69 (Intentional self-poisoning by and exposure to other and unspecified chemicals and noxious substances). This code has been implemented specifically by ED physicians since august 2015;- a suspect case was defined as ED visit coded: F11 (Mental and behavioral disorders due to use of opioids), F12 (Mental and behavioral disorders due to use of cannabinoids), F16 (Mental and behavioral disorders due to use of hallucinogens), F18 (Mental and behavioral disorders due to use of volatile solvents), F19 (Mental and behavioral disorders due to multiple drug use and use of other psychoactive substances).Based on these data, an epidemic curve and a descriptive analysis of ED visits were carried out.ResultsIn total, 146 ED visits related to adverse events associated with use of SC were registered from January 1st, 2012 to October 30, 2016. The epidemic curve shows two waves between 2015 and 2016 with a particularly high peak in August 2015 (Figure 1). In total, 49% (n=72/146) of these ED visits were probably related to adverse reactions associated to use SC and 51% (n=74/146) meet to the suspect case definition. On the surveillance period, men represented 84% of the patients (n=122) and median age (min – max) was 23 (8-62) years old. When the severity score variable was filled (n = 138), a vital emergency was reported for 4% (n = 5) of patients and 19% of patients were hospitalized.ConclusionsData from syndromic surveillance system allowed to confirm an increase in ED visits related to adverse reactions associated with use of SC in Mayotte Island. To our knowledge, it’s the first time that an outbreak related to use SC is described in the Ocean Indian areaThis phenomenon was particularly marked in 2015 with a peak of ED visits on August 2016.After this outbreak, the regional unit of the French national public health agency recommended the pursuit of the coding X69 in principal diagnosis with the following case definition: any patient with an adverse reaction attributed to synthetic cannabinoid use whether suspected by the medical team or declared by the patient himself or if the patient is in possession of the substance; and to raise awareness ED physicians to the notification of these poisonings to the Regional Addictive Surveillance Center.In conclusion, the young population, weakened by a precarious socio-economic situation, is a target for new synthetic drugs and a threat to public health. This emerging risk in Mayotte must be taken into account and must be actively monitored. In this context, collaborative work with the emergency services must continue in parallel with targeted prevention measures.References1. Vilain P, Maillard O, Raslan-Loubatie J, Abdou MA, Lernout T, Filleul L. Usefulness of Syndromic Surveillance for Early Outbreak Detection in Small Islands: The Case of Mayotte. Online Journal of Public Health Informatics. 2013;5(1):e149.

scholarly journals Characterizing the Effects of Extreme Cold Using Real-time Syndromic Surveillance, Ontario, Canada, 2010-2016

2017 ◽  
Vol 132 (1_suppl) ◽  
pp. 48S-52S ◽  
Author(s):  
Nancy VanStone ◽  
Adam van Dijk ◽  
Timothy Chisamore ◽  
Brian Mosley ◽  
Geoffrey Hall ◽  
...  
Keyword(s):  
Public Health ◽  
Acute Care ◽  
Surveillance System ◽  
Syndromic Surveillance ◽  
Cold Temperature ◽  
Syndromic Surveillance System ◽  
Southern Ontario ◽  
Threshold Temperatures ◽  
Ed Visits ◽  
Extreme Cold

Morbidity and mortality from exposure to extreme cold highlight the need for meaningful temperature thresholds to activate public health alerts. We analyzed emergency department (ED) records for cold temperature–related visits collected by the Acute Care Enhanced Surveillance system—a syndromic surveillance system that captures data on ED visits from hospitals in Ontario—for geographic trends related to ambient winter temperature. We used 3 Early Aberration Reporting System algorithms of increasing sensitivity—C1, C2, and C3—to determine the temperature at which anomalous counts of cold temperature–related ED visits occurred in northern and southern Ontario from 2010 to 2016. The C2 algorithm was the most sensitive detection method. Results showed lower threshold temperatures for Acute Care Enhanced Surveillance alerts in northern Ontario than in southern Ontario. Public health alerts for cold temperature warnings that are based on cold temperature–related ED visit counts and ambient temperature may improve the accuracy of public warnings about cold temperature risks.

scholarly journals Flexibility of ED surveillance system to monitor dengue outbreak in Reunion Island

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Pascal Vilain ◽  
Muriel Vincent ◽  
Anne Fouillet ◽  
Katia Mougin-Damour ◽  
Xavier Combes ◽  
...  
Keyword(s):  
Public Health ◽  
Surveillance System ◽  
Syndromic Surveillance ◽  
Reunion Island ◽  
Regional Office ◽  
Syndromic Surveillance System ◽  
Dengue Outbreak ◽  
Icd 10 ◽  
Réunion Island ◽  
Ed Visits

ObjectiveTo describe the characteristics of ED vitis related to dengue fever and to show how the syndromic surveillance system can be flexible for the monitoring of this outbreak.IntroductionIn Reunion Island, a French overseas territory located in the southwestern of Indian Ocean, the dengue virus circulation is sporadic. Since 2004, between 10 and 221 probable and confirmed autochthonous dengue fever cases have been reported annually. Since January 2018, the island has experienced a large epidemic of DENV serotype 2. As of 4 September 2018, 6,538 confirmed and probable autochthonous cases have been notified1. From the beginning of the epidemic, the regional office of National Public Health Agency (ANSP) in Indian Ocean enhanced the syndromic surveillance system in order to monitor the outbreak and to provide hospital morbidity data to public health authorities.MethodsIn Reunion Island, the syndromic surveillance system called OSCOUR® network (Organisation de la Surveillance Coordonnée des Urgences) is based on all emergency departments (ED)2. Anonymous data are collected daily directly from the patients’ computerized medical files completed during medical consultations. Every day, data files are sent to the ANSP via a regional server over the internet using a file transfer protocol. Each file transmitted to ANSP includes all patient visits to the ED logged during the previous 24 hours (midnight to midnight). Finally, data are integrated in a national database (including control of data quality regarding authorized thesauri) and are made available to the regional office through an online application3.Following the start of dengue outbreak in week 4 of 2018, the regional office organized meetings with physicians in each ED to present the dengue epidemiological update and to recommend the coding of ED visit related to dengue for any suspect case (acute fever disease and two or more of the following signs or symptoms: nausea, vomiting, rash, headache, retro-orbital pain, myalgia). During these meetings, it was found that the version of ICD-10 (International Classification of Diseases) was different from one ED to another. Indeed, some ED used A90, A91 (ICD-10 version: 2015) for visit related to dengue and others used A97 and subdivisions (ICD-10 version: 2016). As the ICD-10 version: 2015 was implemented at the national server, some passages could be excluded. In this context, the thesaurus of medical diagnosis implemented in the national database has been updated so that all codes can be accepted. ED visits related to dengue fever has been then described according to age group, gender and hospitalization.ResultsFrom week 9 of 2018, the syndromic surveillance system was operational to monitor dengue outbreak. The regional office has provided each week, an epidemic curve of ED visits for dengue and a dashboard on descriptive characteristic of these visits. In total, 441 ED visits for dengue were identified from week 9 to week 34 of 2018 (Figure 1). On this period, the weekly number of ED visits for dengue was correlated with the weekly number of probable and confirmed autochthonous cases (rho=0.86, p<0.001). Among these visits, the male/female ratio was 0.92 and median (min-max) age was 44 (2-98) years. The distribution by age group showed that 15-64 year-old (72.1%, n=127) were most affected. Age groups 65 years and more and 0-14 year-old represented respectively 21.8% (n=96) and 6.1% (n=27) of dengue visits. About 30% of dengue visits were hospitalized.ConclusionsAccording Buehler et al., “the flexibility of a surveillance system refers to the system's ability to change as needs change. The adaptation to changing detection needs or operating conditions should occur with minimal additional time, personnel, or other resources. Flexibility generally improves the more data processing is handled centrally rather than distributed to individual data-providing facilities because fewer system and operator behavior changes are needed...” 4.During this dengue outbreak, the syndromic surveillance system seems to have met this purpose. In four weeks (from week 5 to week 9 of 2018), the system was able to adapt to the epidemiological situation with minimal additional resources and personnel. Indeed, updates were not made in the IT systems of each EDs’ but at the level of the national ANSP server (by one person). This surveillance system was also flexible thank to the reactivity of ED physicians who timely implemented coding of visits related to dengue fever.In conclusion, ED surveillance system constitutes an added-value for the dengue outbreak monitoring in Reunion Island. The automated collection and analysis data allowed to provide hospital morbidity (severe dengue) data to public health authorities. Although the epidemic has decreased, this system also allows to continue a routine active surveillance in order to quickly identify a new increase.References1Santé publique France. Surveillance de la dengue à la Réunion. Point épidémiologique au 4 septembre 2018. http://invs.santepubliquefrance.fr/fr/Publications-et-outils/Points-epidemiologiques/Tous-les-numeros/Ocean-Indien/2018/Surveillance-de-la-dengue-a-la-Reunion.-Point-epidemiologique-au-4-septembre-2018. [Accessed September 8, 2018].2Vilain P, Filleul F. La surveillance syndromique à la Réunion : un système de surveillance intégré. [Syndromic surveillance in Reunion Island: integrated surveillance system]. Bulletin de Veille Sanitaire. 2013;(21):9-12. http://invs.santepubliquefrance.fr/fr/Publications-et-outils/Bulletin-de-veille-sanitaire/Tous-les-numeros/Ocean-indien-Reunion-Mayotte/Bulletin-de-veille-sanitaire-ocean-Indien.-N-21-Septembre-2013. [Accessed September 4, 2018].3Fouillet A, Fournet N, Caillère N et al. SurSaUD® Software: A Tool to Support the Data Management, the Analysis and the Dissemination of Results from the French Syndromic Surveillance System. OJPHI. 2013; 5(1): e118.4Buehler JW, Hopkins RS, Overhage JM, Sosin DM, Tong V; CDC Working Group. Framework for evaluating public health surveillance systems for early detection of outbreaks: recommendations from the CDC Working Group. MMWR Recomm Rep. 2004;53(RR-5):1-11.

scholarly journals Early evaluation of impacts of cold waves and floods during winter 2018 in France

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Anne Fouillet ◽  
Cecile Forgeot ◽  
Marie-Michele Thiam ◽  
Celine Caserio-Schonemann
Keyword(s):  
Public Health ◽  
Surveillance System ◽  
Syndromic Surveillance ◽  
Health Agency ◽  
Health Impact ◽  
Cold Weather ◽  
Cold Wave ◽  
Seine River ◽  
Syndromic Surveillance System ◽  
Paris Area

ObjectiveThe presentation describes the results of the daily monitoring of health indicators conducted by the French public health agency during the major floods and the cold wave that occurred in January 2018 in France, in order to early identify potential impact of those climatic events on the population.IntroductionThe Seine River rises at the north-East of France and flows through Paris before emptying into the English Channel. On January 2018 (from 22th January to 11th February, Weeks 4 to 6), major floods occurred in the Basin of Seine River, after an important rainy period. This period was also marked by the occurrence on the same area of a first cold wave on Week 6 (from 5th to 7th February), including heavy snowfall and ice conditions from 9th to 10th February. A second similar cold wave occured from 28th February and 1st March.Floods of all magnitude are known to have potential health impacts on population [1], both at short, medium and long term both on physical (injuries, diarrhoeal disease, Carbon Monoxyde poisoning, vector-borne disease) and mental health. Extreme cold weather have also the potential to further impact on human health through direct exposure to lower temperatures, and associated adverse conditions, such as snow and ice [2]. Such situations may be particularly associated to direct impact like hypothermia, frostbite and selected bone/joint injuries).MethodsSince 2004, the French Public Health Agency (Santé publique France) set up a national syndromic surveillance system SurSaUD, enabling to ensure morbidity and mortality surveillance [3]. In 2018, morbidity data were daily collected from a network involving about 700 emergency departments (ED) and 58 emergency general practitioners’ associations SOS Médecins. 92% of the national ED attendances and 95% of national SOS Médecins visits are caught by the system.Both demographic (age and gender), administrative (date and location of consultation, transport) and medical information (chief complaint, medical diagnosis using ICD10 codes in ED and specific thesauri in SOS Médecins associations, severity, hospitalization after discharge) are recorded for each patient.The daily and weekly evolution of the number of all-cause ED attendances and SOS Médecins consultations during the flooding period were compared to the evolution on the two previous years. The number of hospitalisations after ED discharge was also monitored. The immediate health impact of floods and cold waves was assessed by monitoring eight syndromic indicators: gastroenteritis, carbon monoxide poisoning, burnt, stress, faintness, drowning, injuries and hypothermia.Analyses were performed by age group (<15 years, 15-64 years, more than 65 years) and at different geographical levels (national, Paris region and districts located in the Basin of Seine River).ResultsIn 2018, syndromic surveillance did not show any major impact on all-cause ED attendances and SOS Médecins consultations from week 4 to week 6, neither in Paris area nor in other areas along the Seine River. The recorded numbers were comparable to the two precedent years in all age groups.A decrease of the all-cause ED attendances was observed during the 1st day with ice conditions in Normandy and Paris, mainly in children and adults aged 15-64 years.During week 6 in Paris area, an increase of ED attendances was observed for injuries (+4% compared to the past weeks – figure 1) and to a lesser extent for hypothermia and frostbite (16 attendances compared to less than 9 for the past weeks). Similar increase in injuries were observed in Normandy during the second cold wave (Figure 1).ConclusionsDuring the flood episode, the rising water level was slow with foreseeable evolution, compared to other sudden flood events occurring in south of France in 2010 due to violent thunderstorms. This progressive evolution allows French authority to deploy wide specific organization in order to mitigate impact on concerned populations. That may explain the absence impact observed in ED at regional and national levels during the flood disaster. The evolution of injuries during 2018 episode is attributable to the cold wave that occurred simultaneously.As the French syndromic surveillance system is implemented on the whole territory and collects emergency data routinely since several years, it constitutes a reactive tool to assess the potential public health impact of both sudden and predictable disasters. It can either contribute to adapt management action or reassure decision makers if no major impact is observed.References[1] Ahern M, Kovats S. The health impacts of floods. In: Few R, Matthies F, eds. Flood hazards and health: responding to present and future risks. London, Earthscan, 2006:28–53.[2] Hughes H, Morbey R, Hughes T. et al. Using an Emergency Department Syndromic Surveillance System to investigate the impact of extreme cold weather events Public Health. 2014 Jul;128(7):628-35.[3] Caserio-Schönemann C, Bousquet V, Fouillet A, Henry V. The French syndromic surveillance system SurSaUD (R). Bull Epidémiol Hebd 2014;3-4:38-44.

scholarly journals Enhanced syndromic surveillance during the 9 th Indian Ocean Island Games, 2015

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Pascal Vilain ◽  
Frédéric Pages ◽  
Guy Henrion ◽  
Xavier Combes ◽  
Marc Weber ◽  
...  
Keyword(s):  
Public Health ◽  
Surveillance System ◽  
Syndromic Surveillance ◽  
Reunion Island ◽  
Mass Gathering ◽  
Secondary Diagnosis ◽  
Syndromic Surveillance System ◽  
Ocean Island ◽  
Réunion Island ◽  
Ed Visits

ObjectiveTo describe how syndromic surveillance was enhanced to detecthealth events during the 9thIndian Ocean Island Games (IOIG) inReunion Island.IntroductionThe 9thIOIG took place in Reunion Island from July 31 to August9, 2015. This sport event gathered approximatively 1 640 athletes,2 000 volunteers and several thousand spectators from seven islands:Comoros, Madagascar, Maldives, Mauritius, Mayotte, Seychelles andReunion.In response to the import risk of infectious diseases from thesecountries where some of them are endemics, the syndromicsurveillance system, which captures 100% of all EmergencyDepartment visits, was enhanced in order to detect any health event.MethodsIn Reunion Island, syndromic surveillance system is based onOSCOUR® network (Organisation de la surveillance coordonnéedes urgences) that collects data from all emergency departments ofthe island. Data are daily transmitted to the French national publichealth agency then are available to the regional office. At the regionallevel, data are integrated into an application that allows the built ofpredefined syndromic groups according to the health risks related tomass gatherings (Table 1, parts 1 to 3) and complemented by specificsyndromic groups (table 1, part 4). Daily analyses with temporal[1] and spatial-temporal [2] algorithms were performed during thesurveillance period of July 27 to August 13, 2015. In addition to thismonitoring, ED physicians were requested to proactively tag Y33(ICD-10) as secondary diagnosis, each ED visits related to IOIG. Linelists were reviewed daily. Each day, an epidemiological report wassend to public health authorities.ResultsFrom July 31 to August 9, 2015, the activity of EDs was inaccordance with that expected. No health events were detected bythe syndromic surveillance system except for the syndrome “alcoholintoxication” for which consecutive signals were observed fromAugust 6 to 9, 2015. This increase occurs commonly at the beginningof each month (due to the social benefits payday) [3] nevertheless thisevent has probably been increased by IOIG (finals for team sportsand games closing ceremony). In total, 8 ED visits were tagged Y33as secondary diagnosis. In over half the cases, visits were related totrauma.ConclusionsThe syndromic surveillance system proved to be useful for thesurveillance of mass gathering events due to its capacity to detecthealth events but also to provide reassurance public health authorities[4]. As described in literature [5], few ED visits were tagged in relationto IOIG. Indeed, the tag of ED visits was implemented two weeksbefore the games, and given the shifts of ED physicians, some of themmay have not been informed. In the future, preparation meetings withphysicians will have to be planned several months before in order toimprove the response rate for mass gathering events.

scholarly journals Building a Better Syndromic Surveillance System: the New York City Experience

2015 ◽  
Vol 7 (1) ◽  
Author(s):  
Robert Mathes ◽  
Jessica Sell ◽  
Anthony W. Tam ◽  
Alison Levin-Rector ◽  
Ramona Lall
Keyword(s):  
New York ◽  
New York City ◽  
York City ◽  
Surveillance System ◽  
Syndromic Surveillance ◽  
Alternative Methods ◽  
Detection Methods ◽  
Syndromic Surveillance System ◽  
Aberration Detection ◽  
Ed Visits

The New York City (NYC) syndromic surveillance system has been monitoring syndromes from city emergency department (ED) visits since 2001. We conducted an evaluation of statistical aberration detection methods currently in use in our system as well as alternative methods, applying six temporal and four spatio-temporal aberration detection methods to two years of ED visits in NYC spiked with synthetic outbreaks. We found performance varied between the methods in regard to sensitivity, specificity, and timeliness, and implementation of these methods will depend on needs, frequency of signals, and technical skill.

scholarly journals Precision public health through clinic-based syndromic surveillance in communities

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Ta-Chien Chan ◽  
Yung-Chu Teng ◽  
Yen-Hua Chu ◽  
Tzu-Yu Lin
Keyword(s):  
Public Health ◽  
Surveillance System ◽  
Disease Surveillance ◽  
Syndromic Surveillance ◽  
Early Stage ◽  
Age Distribution ◽  
Local Health ◽  
Syndromic Surveillance System ◽  
Taipei City ◽  
Kaohsiung City

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.References1. James W. Buehler AS, Marc Paladini, Paula Soper, Farzad Mostashari: Syndromic Surveillance Practice in the United States: Findings from a Survey of State, Territorial, and Selected Local Health Departments. Advances in Disease Surveillance 2008, 6(3).2. Ding Y, Fei Y, Xu B, Yang J, Yan W, Diwan VK, Sauerborn R, Dong H: Measuring costs of data collection at village clinics by village doctors for a syndromic surveillance system — a cross sectional survey from China. BMC Health Services Research 2015, 15:287.3. Kao JH, Chen CD, Tiger Li ZR, Chan TC, Tung TH, Chu YH, Cheng HY, Liu JW, Shih FY, Shu PY et al.: The Critical Role of Early Dengue Surveillance and Limitations of Clinical Reporting -- Implications for Non-Endemic Countries. PloS one 2016, 11(8):e0160230.4. Chan TC, Hu TH, Hwang JS: Daily forecast of dengue fever incidents for urban villages in a city. International Journal of Health Geographics 2015, 14:9.5. Chan TC, Teng YC, Hwang JS: Detection of influenza-like illness aberrations by directly monitoring Pearson residuals of fitted negative binomial regression models. BMC Public Health 2015, 15:168.6. Ma HT: Syndromic surveillance system for detecting enterovirus outbreaks evaluation and applications in public health. Taipei, Taiwan: National Taiwan University; 2007. 

Monitoring Emergency Department Visits From Puerto Rico in the Aftermath of Hurricane Maria Using Syndromic Surveillance – New York City, 2017

2019 ◽  
Vol 14 (1) ◽  
pp. 44-48
Author(s):  
Priscilla W. Wong ◽  
Hilary B. Parton
Keyword(s):  
Emergency Department ◽  
New York ◽  
New York City ◽  
Puerto Rico ◽  
York City ◽  
Surveillance System ◽  
Syndromic Surveillance ◽  
Situational Awareness ◽  
Syndromic Surveillance System ◽  
Ed Visits

ABSTRACTObjective:Syndromic surveillance has been useful for routine surveillance on a variety of health outcomes and for informing situational awareness during public health emergencies. Following the landfall of Hurricane Maria in 2017, the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) implemented an enhanced syndromic surveillance system to characterize related emergency department (ED) visits.Methods:ED visits with any mention of specific key words (“Puerto,” “Rico,” “hurricane,” “Maria”) in the ED chief complaint or Puerto Rico patient home Zip Code were identified from the DOHMH syndromic surveillance system in the 8-week window leading up to and following landfall. Visit volume comparisons pre- and post-Hurricane Maria were performed using Fisher’s exact test.Results:Analyses identified an overall increase in NYC ED utilization relating to Puerto Rico following Hurricane Maria landfall. In particular, there was a small but significant increase in visits involving a medication refill or essential medical equipment. Visits for other outcomes, such as mental illness, also increased, but the differences were not statistically significant.Conclusions:Gaining this situational awareness of medical service use was informative following Hurricane Maria, and, following any natural disaster, the same surveillance methods could be easily established to aid an effective emergency response.

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

2008 ◽  
Vol 8 (1) ◽  
Author(s):  
Tsung-Shu Joseph Wu ◽  
Fuh-Yuan Frank Shih ◽  
Muh-Yong Yen ◽  
Jiunn-Shyan Julian Wu ◽  
Shiou-Wen Lu ◽  
...  
Keyword(s):  
Public Health ◽  
Emergency Department ◽  
Surveillance System ◽  
Syndromic Surveillance ◽  
Syndromic Surveillance System

scholarly journals Harnessing Syndromic Surveillance Emergency Department Data to Monitor Health Impacts During the 2015 Special Olympics World Games

2017 ◽  
Vol 132 (1_suppl) ◽  
pp. 99S-105S ◽  
Author(s):  
Emily Kajita ◽  
Monica Z. Luarca ◽  
Han Wu ◽  
Bessie Hwang ◽  
Laurene Mascola
Keyword(s):  
Public Health ◽  
Los Angeles ◽  
Surveillance System ◽  
Syndromic Surveillance ◽  
Los Angeles County ◽  
International Travel ◽  
Poison Control ◽  
Special Olympics ◽  
Syndromic Surveillance System ◽  
Mass Gatherings

Introduction: Mass gatherings that attract a large international presence may cause or amplify point-source outbreaks of emerging infectious disease. The Los Angeles County Department of Public Health customized its syndromic surveillance system to detect increased syndrome-specific utilization of emergency departments (EDs) and other medical encounters coincident to the 2015 Special Olympics World Games. Materials and Methods: We queried live databases containing data on ED visits, California Poison Control System calls, and Los Angeles County coroner-investigated deaths for increases in daily counts from July 19 to August 6, 2015. We chose syndrome categories based on the potential for disease outbreaks common to international travel and dormitory settings, morbidity amplified by high temperatures, and bioterrorism threats inherent to mass gatherings. We performed line-list reviews and trend analyses of total, syndrome-specific, and region-specific daily counts, using cumulative sum-based signals. We also piloted a novel strategy of requesting that ED registrars proactively tag Special Olympics attendees in chief complaint data fields. Results: The syndromic surveillance system showed that the 2015 Special Olympics did not generate large-scale acute morbidities leading to detectable stress on local EDs. We recruited 10 hospitals for proactive patient tagging, from which 16 Special Olympics attendees were detected; these patients reported various symptoms, such as injury, vomiting, and syncope. Practice Implications: As an enhancement to traditional syndromic surveillance, proactive patient tagging can illuminate potential epidemiologic links among patients in challenging syndromic surveillance applications, such as mass gatherings. Syndromic surveillance has the potential to enhance ED patient polling and reporting of exposure, symptom, and other epidemiologic case definition criteria to public health agencies in near-real time.

scholarly journals Evaluation of the Components of the North Carolina Syndromic Surveillance System Heat Syndrome Case Definition

2017 ◽  
Vol 132 (1_suppl) ◽  
pp. 40S-47S ◽  
Author(s):  
Laurel Harduar Morano ◽  
Anna E. Waller
Keyword(s):  
North Carolina ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Surveillance System ◽  
Case Definition ◽  
Exclusion Criteria ◽  
Syndromic Surveillance System ◽  
Ed Visits ◽  
Heat Syndrome ◽  
Current Heat

Objectives: To improve heat-related illness surveillance, we evaluated and refined North Carolina’s heat syndrome case definition. Methods: We analyzed North Carolina emergency department (ED) visits during 2012-2014. We evaluated the current heat syndrome case definition (ie, keywords in chief complaint/triage notes or International Classification of Diseases, Ninth Revision, Clinical Modification [ ICD-9-CM] codes) and additional heat-related inclusion and exclusion keywords. We calculated the positive predictive value and sensitivity of keyword-identified ED visits and manually reviewed ED visits to identify true positives and false positives. Results: The current heat syndrome case definition identified 8928 ED visits; additional inclusion keywords identified another 598 ED visits. Of 4006 keyword-identified ED visits, 3216 (80.3%) were captured by 4 phrases: “heat ex” (n = 1674, 41.8%), “overheat” (n = 646, 16.1%), “too hot” (n = 594, 14.8%), and “heatstroke” (n = 302, 7.5%). Among the 267 ED visits identified by keyword only, a burn diagnosis or the following keywords resulted in a false-positive rate >95%: “burn,” “grease,” “liquid,” “oil,” “radiator,” “antifreeze,” “hot tub,” “hot spring,” and “sauna.” After applying the revised inclusion and exclusion criteria, we identified 9132 heat-related ED visits: 2157 by keyword only, 5493 by ICD-9-CM code only, and 1482 by both (sensitivity = 27.0%, positive predictive value = 40.7%). Cases identified by keywords were strongly correlated with cases identified by ICD-9-CM codes (rho = .94, P < .001). Conclusions: Revising the heat syndrome case definition through the use of additional inclusion and exclusion criteria substantially improved the accuracy of the surveillance system. Other jurisdictions may benefit from refining their heat syndrome case definition.

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