scholarly journals Interpreting specific and general respiratory indicators in syndromic surveillance

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Roger Morbey ◽  
Alex J. Elliot ◽  
Maria Zambon ◽  
Richard Pebody ◽  
Gillian E. Smith
Keyword(s):  
Public Health ◽  
Syndromic Surveillance ◽  
Respiratory Illness ◽  
Surveillance Systems ◽  
Respiratory Pathogens ◽  
Family Doctors ◽  
Influenza Like Illness ◽  
Public Health Decision ◽  
Syncytial Virus ◽  
To Receive

ObjectiveTo improve understanding of the relative burden of differentcausative respiratory pathogens on respiratory syndromic indicatorsmonitored using syndromic surveillance systems in England.IntroductionPublic Health England (PHE) uses syndromic surveillance systemsto monitor for seasonal increases in respiratory illness. Respiratoryillnesses create a considerable burden on health care services andtherefore identifying the timing and intensity of peaks of activity isimportant for public health decision-making. Furthermore, identifyingthe incidence of specific respiratory pathogens circulating in thecommunity is essential for targeting public health interventionse.g. vaccination. Syndromic surveillance can provide early warningof increases, but cannot explicitly identify the pathogens responsiblefor such increases.PHE uses a range of general and specific respiratory syndromicindicators in their syndromic surveillance systems, e.g. “allrespiratory disease”, “influenza-like illness”, “bronchitis” and“cough”. Previous research has shown that “influenza-like illness”is associated with influenza circulating in the community1whilst“cough” and “bronchitis” syndromic indicators in children under 5are associated with respiratory syncytial virus (RSV)2, 3. However, therelative burden of other pathogens, e.g. rhinovirus and parainfluenzais less well understood. We have sought to further understand therelationship between specific pathogens and syndromic indicators andto improve estimates of disease burden. Therefore, we modelled theassociation between pathogen incidence, using laboratory reports andhealth care presentations, using syndromic data.MethodsWe used positive laboratory reports for the following pathogens as aproxy for community incidence in England: human metapneumovirus(HMPV), RSV, coronavirus, influenza strains, invasivehaemophilusinfluenzae, invasivestreptococcus pneumoniae, mycoplasmapneumoniae, parainfluenza and rhinovirus. Organisms were chosenthat were found to be important in previous work2and were availablefrom routine laboratory testing. Syndromic data included consultationswith family doctors (called General Practitioners or GPs), calls to anational telephone helpline “NHS 111” and attendances at emergencydepartments (EDs). Associations between laboratory reports andsyndromic data were examined over four winter seasons (weeks40 to 20), between 2011 and 2015. Multiple linear regression was usedto model correlations and to estimate the proportion of syndromicconsultations associated with specific pathogens. Finally, burdenestimates were used to infer the proportion of patients affected byspecific pathogens that would be diagnosed with different symptoms.ResultsInfluenza and RSV exhibited the greatest seasonal variation andwere responsible for the strongest associated burden on generalrespiratory infections. However, associations were found with theother pathogens and the burden ofstreptococcus pneumoniaewasimportant in adult age groups (25 years and over).The model estimates suggested that only a small proportion ofpatients with influenza receive a specific diagnosis that is coded toan “influenza-like illness” syndromic indicator, (6% for both GPin-hours consultations and for emergency department attendances),compared to a more general respiratory diagnosis. Also, patients withinfluenza calling NHS 111 were more likely to receive a diagnosisof fever or cough than cold/flu. Despite these findings, the specificsyndromic indicators remained more sensitive to changes in influenzaincidence than the general indicators.ConclusionsThe majority of patients affected by a seasonal respiratory pathogenare likely to receive a non-specific respiratory diagnosis. Therefore,estimates of community burden using more specific syndromicindicators such as “influenza-like illness” are likely to be a severeunderestimate. However, these specific indicators remain importantfor detecting changes in incidence and providing added intelligenceon likely causative pathogens.Specific syndromic indicators were associated with multiplepathogens and we were unable to identify indicators that were goodmarkers for pathogens other than influenza or RSV. However, futurework focusing on differences between ages and the relative levels ofa range of pathogens may be able to provide estimates for the mix ofpathogens present in the community in real-time.

scholarly journals The Effects of Social Distancing Policies on non-SARS-CoV-2 Respiratory Pathogens

2021 ◽  
Author(s):  
Jeff Nawrocki ◽  
Katherine Olin ◽  
Martin C Holdrege ◽  
Joel Hartsell ◽  
Lindsay Meyers ◽  
...  
Keyword(s):  
Public Health ◽  
Influenza A ◽  
Detection Rate ◽  
Respiratory Illness ◽  
Respiratory Pathogens ◽  
Public Health Response ◽  
Mixed Effect ◽  
Detection Rates ◽  
Social Distancing ◽  
The Impact

Abstract Background The initial focus of the US public health response to COVID-19 was the implementation of numerous social distancing policies. While COVID-19 was the impetus for imposing these policies, it is not the only respiratory disease affected by their implementation. This study aimed to assess the impact of social distancing policies on non-SARS-CoV-2 respiratory pathogens typically circulating across multiple US states. Methods Linear mixed-effect models were implemented to explore the effects of five social distancing policies on non-SARS-CoV-2 respiratory pathogens across nine states from January 1 through May 1, 2020. The observed 2020 pathogen detection rates were compared week-by-week to historical rates to determine when the detection rates were different. Results Model results indicate that several social distancing policies were associated with a reduction in total detection rate, by nearly 15%. Policies were associated with decreases in pathogen circulation of human rhinovirus/enterovirus and human metapneumovirus, as well as influenza A, which typically decrease after winter. Parainfluenza viruses failed to circulate at historical levels during the spring. Total detection rate in April 2020 was 35% less than historical average. Many of the pathogens driving this difference fell below historical detection rate ranges within two weeks of initial policy implementation. Conclusion This analysis investigated the effect of multiple social distancing policies implemented to reduce transmission of SARS-CoV-2 on non-SARS-CoV-2 respiratory pathogens. These findings suggest that social distancing policies may be used as an impactful public health tool to reduce communicable respiratory illness.

scholarly journals Developing Syndromic Surveillance to Monitor and Respond to Adverse Health Events Related to Psychoactive Substance Use: Methods and Applications

2017 ◽  
Vol 132 (1_suppl) ◽  
pp. 65S-72S ◽  
Author(s):  
Michelle L. Nolan ◽  
Hillary V. Kunins ◽  
Ramona Lall ◽  
Denise Paone
Keyword(s):  
Public Health ◽  
New York ◽  
New York City ◽  
York City ◽  
Syndromic Surveillance ◽  
Psychoactive Drug ◽  
Surveillance Systems ◽  
Chief Complaints ◽  
Level Information ◽  
Ed Visits

Introduction: Recent increases in drug overdose deaths, both in New York City and nationally, highlight the need for timely data on psychoactive drug-related morbidity. We developed drug syndrome definitions for syndromic surveillance to monitor drug-related emergency department (ED) visits in real time. Materials and Methods: We used 2012 archived syndromic surveillance data from New York City hospitals to develop definitions for psychoactive drug-related syndromes. The dataset contained ED visit-level information that included patients’ chief complaints, dates of visits, ZIP codes of residence, discharge diagnoses, and dispositions. After manually reviewing chief complaints, we developed a classification scheme comprising 3 categories (overdose, drug mention, and drug abuse/misuse), which we used to define 25 psychoactive drug syndromes. From July 2013 through December 2015, the New York City Department of Health and Mental Hygiene performed daily syndromic surveillance of psychoactive drug-related ED visits using the 25 syndrome definitions. Results: Syndromic surveillance triggered 4 public health investigations, supported 8 other public health investigations that had been triggered by other mechanisms, and resulted in the identification of 5 psychoactive drug-related outbreaks. Syndromic surveillance also identified a substantial increase in synthetic cannabinoid-related visits (from an average of 3 per week in January 2014 to >300 per week in July 2015) and an increase in heroin overdose visits (from 80 to 171 in the first 3 quarters of 2012 and 2014, respectively) in a single neighborhood. Practice Implications: Syndromic surveillance using these novel definitions enabled monitoring of trends in psychoactive drug-related morbidity, initiation and support of public health investigations, and targeting of interventions. Health departments can refine these definitions for their jurisdictions using the described methods and integrate them into existing syndromic surveillance systems.

scholarly journals FluWatchers: Evaluation of a crowdsourced influenza-like illness surveillance application for Canadian influenza seasons 2015–2016 to 2018–2019

2021 ◽  
Vol 47 (09) ◽  
pp. 357-363
Author(s):  
Liza Lee ◽  
Mireille Desroches ◽  
Shamir Mukhi ◽  
Christina Bancej
Keyword(s):  
Respiratory Virus ◽  
Evaluation Criteria ◽  
Influenza Surveillance ◽  
Surveillance Program ◽  
Surveillance Systems ◽  
Virus Infections ◽  
Detection Rates ◽  
Influenza Like Illness ◽  
Syncytial Virus ◽  
Participatory Surveillance

Background: Sentinel influenza-like illness (ILI) surveillance is an essential component of a comprehensive influenza surveillance program. Community-based ILI surveillance systems that rely solely on sentinel healthcare practices omit important segments of the population, including those who do not seek medical care. Participatory surveillance, which relies on community participation in surveillance, may address some limitations of traditional ILI systems. Objective: We aimed to evaluate FluWatchers, a crowdsourced ILI application developed to complement and complete ILI surveillance in Canada. Methods: Using established frameworks for surveillance evaluations, we assessed the acceptability, reliability, accuracy and usefulness of the FluWatchers system 2015–2016, through 2018–2019. Evaluation indicators were compared against national surveillance indicators of ILI and of laboratory confirmed respiratory virus infections. Results: The acceptability of FluWatchers was demonstrated by growth of 50%–100% in season-over-season participation, and a consistent season-over-season retention of 80%. Reliability was greater for FluWatchers than for our traditional ILI system, although both systems had week-over-week fluctuations in the number of participants responding. FluWatchers’ ILI rates had moderate correlation with weekly influenza laboratory detection rates and other winter seasonal respiratory virus detections including respiratory syncytial virus and seasonal coronaviruses. Finally, FluWatchers has demonstrated its usefulness as a source of core FluWatch surveillance information and has the potential to fill data gaps in current programs for influenza surveillance and control. Conclusion: FluWatchers is an example of an innovative digital participatory surveillance program that was created to address limitations of traditional ILI surveillance in Canada. It fulfills the surveillance system evaluation criteria of acceptability, reliability, accuracy and usefulness.

scholarly journals What did Syndromic Surveillance Show During London 2012? Lessons for Mass Gatherings

2015 ◽  
Vol 7 (1) ◽  
Author(s):  
Dan Todkill ◽  
Helen Hughes ◽  
Alex Elliot ◽  
Roger Morbey ◽  
Obaghe Edeghere ◽  
...  
Keyword(s):  
Public Health ◽  
General Practitioner ◽  
Syndromic Surveillance ◽  
Lessons Learned ◽  
Surveillance Systems ◽  
Mass Gathering ◽  
Daily Number ◽  
Mass Gatherings ◽  
London 2012 ◽  
The Impact

This paper investigates the impact of the London 2012 Olympic and Paralympic Games on syndromic surveillance systems coordinated by Public Health England. The Games had very little obvious impact on the daily number of ED attendances and general practitioner consultations both nationally, and within London. These results provide valuable lessons learned for future mass gathering events.

scholarly journals Delay between Discharge and Admit Time Delay in ADT-A03 messages via LEEDS

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Jose Serrano
Keyword(s):  
Public Health ◽  
Syndromic Surveillance ◽  
Surveillance Systems ◽  
Hospital Emergency ◽  
Timely Manner ◽  
Disease Epidemiology ◽  
Infectious Disease Epidemiology ◽  
The Difference ◽  
Disease Specific

ObjectiveTo explore the difference between the reported date of admissionand discharge date using discharge messages (A03), from hospitalemergency departments participating in the Louisiana Early EventDetection System (LEEDS.IntroductionThe Infectious Disease Epidemiology Section (IDEpi) within theOffice of Public Health (LaOPH) conducts syndromic surveillanceof emergency departments by means of the Louisiana Early EventDetection System (LEEDS). LEEDS accepts ADT (admit-discharge-transfer) messages from participating hospitals, predominately A04(registration) and A03 (discharge), to obtain symptom or syndromeinformation on patients reporting to hospital emergency departments.Capturing the data using discharge messages (A03) only could resultin a delay in receipt of data by LaOPH, considering the variability inthe length of stay of a patient in the ED.MethodsEmergency department data from participating hospitals isimported daily to LEEDS and processed for syndrome classification.IDEpi syndromic surveillance messages received for the period ofCDC week 1632 and 1636 (8/8/16-9/8/16) using MS Access andExcel to calculate the difference (in days) between the reported admitdate and discharge date in A03 messages.Results88.1% of the A03 messages submitted in the 4 week analysisperiod exhibited no delay (delay=0 days) between the admit date andthe reported discharge date, compared to only 10.7% showing a delayof one day (delay = 1 day) and 1.06% showing a delay of 2 days ormore (delay≥2 days). Less than 0.2% of the messages had missinginformation regarding discharge date (Table 1).ConclusionsSyndromic surveillance systems operate under a constant need forimprovement and enhancement. The quality of the data, independentof the quality of the system, should always strive to be of the highestpedigree in order to inform disease-specific programs and detectpublic health aberrations. In order to identify these potential concerns,it is imperative that the data be submitted to public health agenciesin a timely manner. Based on this analysis, the lapse in time betweenadmit and discharge results in little to no patient syndromic data delayfor those hospital ED’s that exclusively send A03 messages. Thisstatement is supported by the finding that close to 99% of messagesdemonstrated a delay between admit date and discharge date of oneday or less.Table 1. Delay between reported Admit and Discharge date in A03 messagessubmitted to LEEDS

scholarly journals Identifying and Communicating the Importance of the Variable Nature of SyS Data

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Heather Rubino ◽  
David Atrubin ◽  
Janet J. Hamilton
Keyword(s):  
Public Health ◽  
Trend Analysis ◽  
Subject Matter ◽  
General Public ◽  
Syndromic Surveillance ◽  
Surveillance Systems ◽  
Subject Matter Experts ◽  
Variable Nature ◽  
The Media ◽  
Time Evaluation

ObjectiveThis roundtable will provide a forum for national, state, and localmanagers of syndromic surveillance systems to discuss how theyidentify, monitor, and respond to changes in the nature of their data.Additionally, this session will focus on the strengths and weaknessof the syndromic surveillance systems for supporting programevaluation and trend analysis. This session will also provide a forumwhere subject matter experts can discuss the ways in which this deepunderstanding of their data can be leveraged to forge and improvepartnerships with academic partners.IntroductionAs syndromic surveillance systems continue to grow, newopportunities have arisen to utilize the data in new or alternativeways for which the system was not initially designed. For example,in many jurisdictions syndromic surveillance has recently becomepopulation-based, with 100% coverage of targeted emergencydepartment encounters. This makes the data more valuable for real-time evaluation of public health and prevention programs. There hasalso been increasing pressure to make more data publicly available –to the media, academic partners, and the general public.

scholarly journals Based on Transcriptome Sequencing: Clinicians Need to Pay Attention to Fever Caused by Common Respiratory Pathogens During the Global Outbreak of COVID-19

2021 ◽  
Author(s):  
Sheng Yin ◽  
Zeyou Wang ◽  
Min Wang ◽  
Wenlong Wang
Keyword(s):  
Public Health ◽  
Nucleic Acid ◽  
Influenza A ◽  
De Novo ◽  
Respiratory Pathogens ◽  
Public Health Decision ◽  
Significant Difference ◽  
B Virus ◽  
Health Decision ◽  
Observational Cohort

Abstract Objectives:During the COVID-19 pandemic, clinicians and public health decision-makers especially focus on fever patients. Other common pathogens that may cause fever are easily overlooked. We aimed to describe the pathogen infection and epidemic trend of non-SARS-CoV-2 occurring in hospitalized patients.Methods:An observational cohort study of 733 consecutive patients admitted to Hospital Clinic of the Second Xiangya Hospital for COVID-19. All samples of a pharyngeal swab from patients with fever have been tested for nucleic acid and immune antigens of SARS-CoV-2 and Influenza A/B virus. 649 fever patients have been tested for nucleic acid in ten respiratory pathogens. Macrotranscriptome sequencing was performed on 26 samples.Results:Of a total of 733 patients with fever, 2.05% patients had confirmed SARS-CoV-2 infections. Fever patients with common respiratory pathogens in fever patients was 8.78%. There is no integration phenomenon between SARS-Cov-2 and the human genome. SARS-CoV-2 positive samples will also be infected with other viruses, especially adenovirus. Macrotranscript analysis showed that there was no significant difference in the species and genus levels of pathogens between Covid-19 patients and other fever patients. The main pathways that affect human metabolism after SARS-Cov-2 infection are the Calvin-Benson-Bassham cycle, pyrimidine deoxyribonucleotides de novo biosynthesis I and D-galactose degradation V.Conclusions:Most patients have a fever caused by common respiratory pathogens. Clinicians still need to pay more attention to infections of common respiratory pathogens in addition to SARS-CoV-2. China's public health measures to stop the spread of the epidemic have proven effective.

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