scholarly journals Coordinated Enhanced Surveillance with Healthcare Entities for Mass Gathering Events

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Erin E. Austin
Keyword(s):  
Public Health ◽  
Syndromic Surveillance ◽  
Lessons Learned ◽  
Surveillance Systems ◽  
Mass Gathering ◽  
Functional Requirements ◽  
Specific Field ◽  
Mass Gatherings ◽  
Ed Visits ◽  
The U.S

ObjectiveTo describe the planning strategies and lessons learned by theVirginia Department of Health (VDH) when conducting enhancedsurveillance during mass gathering events and coordinating withhealthcare entities to distinguish event-related emergency department(ED) visits from community-related ED visits.IntroductionMass gatherings can result in morbidity and mortality fromcommunicable and non-communicable diseases, injury, andbioterrorism. Therefore, it is important to identify event-related visitsas opposed to community-related visits when conducting publichealth surveillance1. Previous mass gatherings in Virginia havedemonstrated the importance of implementing enhanced surveillanceto facilitate early detection of public health issues to allow for timelyresponse2.MethodsBetween June 2015 and September 2015, VDH coordinatedwith two healthcare entities representing six acute care hospitalsto conduct enhanced surveillance for the 2015 World Police andFire Games and 2015 Union Cycliste Internationale (UCI) RoadWorld Championships. VDH established initial communicationwith each healthcare entity between 1 week to 2 months before theevent start date to discuss functional requirements with technical,informatics, and clinical staff. Requirements included: 1) health careentity identifying gathering attendees during the ED registration, 2)capturing a standardized mass gathering indicator within the patient’selectronic health record (EHR), and 3) transmitting the gatheringindicator to VDH through existing electronic syndromic surveillancereporting processes. ED visit records with the gathering indicator wereanalyzed by VDH using the Virginia Electronic Surveillance Systemfor the Notification Community-based Epidemics (ESSENCE) andfindings were incorporated in daily VDH situational reports. Thissame methodology will be applied for the upcoming U.S. VicePresidential Debate in October 2016.ResultsThe duration of the two gatherings in 2015 ranged from 9 to 10 daysand the locations were categorized as urban. The population densityof the gathering location ranged from 1,950 to 2,889 populationper square mile. The estimated number of attendees ranged from45,000 to 400,000. Attendees were defined as having attended at leastone day of the mass gathering event. The mass gathering indicatorcaptured during the ED registration included the gathering acronymor a gathering specific field with a drop down menu containingtrue/false options. VDH utilized ESSENCE to identify 42 ED visits(0.5%) with the gathering acronym out of 8,768 total ED visits duringthe 2015 World Police and Fire Games and 60 ED visits (2.6%)with the gathering specific field out of 2,296 total visits during the2015 UCI Road World Championships. The results of the U.S. VicePresidential Debate in October 2016 are pending.ConclusionsIn 2015, VDH partnered with two healthcare entities to conductenhanced surveillance during two mass gatherings. Although VDHroutinely uses syndromic surveillance data to identify issues of publichealth concern, it has previously lacked the ability to identify EDvisits specific to mass gatherings. Prior to collaboration with VDH,the healthcare entities did not capture gathering-specific ED visitsusing their EHR systems. The two healthcare entities successfullymodified their business procedures and EHR system to capture andtransmit a gathering indicator for ED visits despite some challenges.These challenges include constraints with customization of theEHR and syndromic surveillance systems, lack of standardizedtraining among ED registration staff for interpreting and applyingthe gathering indicator, and limited functionality testing prior tothe event. Lessons learned from this coordinated effort are to: 1)initiate the planning phase and identification of requirements as earlyas possible to ensure they are well defined and understandable, 2)implement frequent communications with the healthcare entity,and 3) customize requirements for the specific gathering as muchas possible while balancing the burden and benefit to public healthand the healthcare entity. The coordinated enhanced surveillanceefforts provided both VDH and the healthcare entities with improvedsituational awareness and capacity building during mass gatheringevents. The strategies and lessons learned from these two events willbe applied to improve enhanced surveillance of public health issuesduring future mass gatherings, including the U.S. Vice PresidentialDebate in October 2016.

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 Using State and National Surveillance Systems during World Equestrian Games in NC

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Lana Deyneka ◽  
Zachary Faigen ◽  
Anne Hakenwerth ◽  
Nicole Lee ◽  
Amy Ising ◽  
...  
Keyword(s):  
Public Health ◽  
Syndromic Surveillance ◽  
Urgent Care ◽  
Poison Center ◽  
Surveillance Systems ◽  
Mass Gathering ◽  
Mass Gatherings ◽  
Epidemic Intelligence ◽  
Polk County ◽  
Ed Visits

ObjectiveTo describe surveillance activities and use of existing state (NC DETECT) and national (NSSP) syndromic surveillance systems during the International Federation for Equestrian Sports (FEI) World Equestrian Games (WEG), in Mill Spring, NC from September 11 to September 23, 2018MethodsNC DETECT collects statewide data from hospital emergency department (ED) visits and Carolinas Poison Center (CPC) calls. NC DETECT also collects data from select Urgent Care Centers (UCC) in the Charlotte area. CPC data are updated hourly, while ED data are updated twice a day. NC DETECT data were monitored daily for census (total ED visits), communicable disease syndromes, injury syndromes, and other occurrences of public health significance related to the event. The geographic areas monitored were Polk County (the location of the main event), the counties where the guests were lodging in the Western NC Region (Henderson, Transylvania, Buncombe, Rutherford, McDowell, and Cleveland), the Charlotte Metropolitan area, and statewide. Because of the large number of people from other states and countries who attended, ED surveillance was mainly conducted by hospitals so that visits were captured for all patients and not just NC residents. WEG dashboards containing ED data were created prior to the event using NC DETECT and NSSP ESSENCE systems, and were accessible to epidemiologists at the state level. NSSP syndrome queries were shared with the neighboring state (SC) public health agency. Surveillance began two weeks prior to the event to establish baseline levels for all ED visits for hospitals in Polk County and the Western NC Region. Surveillance occurred daily before the event, during the event, and for two weeks following the event to account for incubation periods of potential diseases.ResultsThe 2018 Equestrian games in Western NC were affected by heavy rain and heat. The weather led to low attendance and cancellation of a few competitions. During the observation period, ED admissions and most of the mass gathering related syndromes in both NC DETECT and NSSP systems were at baseline. ED admissions for motor vehicle collisions and dehydration syndromes were above baseline for 09/19 and 09/21/18 (Figures 3-4). CPC calls and UC admissions for selected UC centers in the Charlotte area were also monitored, and were at baseline.ConclusionsNC DETECT and NSSP Dashboards provided effective and timely surveillance for the WEG event to assist local public health in the rural NC area with epidemiologic investigations and appropriate response. NC DETECT’s CPC and UC data provided additional valuable information, and complemented ED surveillance during the mass gathering event. Syndromic surveillance became essential during WEG, as NC DPH deployment plans and resource availability changed when Hurricane Florence bore down on the region.References1. Joseph S. Lombardo, Carol A. Sniegoski, Wayne A. Loschen, Matthew Westercamp, Michael Wade, Shandy Dearth, and Guoyan Zhang Public Health Surveillance for Mass Gatherings Johns Hopkins APL Technical Digest , Volume 27, Number 4 (2008)2. Kaiser R, Coulombier D. Epidemic intelligence during mass gatherings. Euro Surveill. 2006;113. Ising A, Li M, Deyneka L, Vaughan-Batten H, Waller A. Improving syndromic surveillance for nonpower users: NC DETECT dashboards. Emerging Health Threats Journal 2011, 4: 11702 - DOI: 10.3402/ehtj.v4i0.11702 

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 Using ESSENCE to Detect Bomb-Making Activity: What’s Appropriate?

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Andrew Torgerson
Keyword(s):  
Public Health ◽  
Law Enforcement ◽  
Syndromic Surveillance ◽  
Chief Complaint ◽  
Surveillance Data ◽  
Chemical Mechanism ◽  
Mass Gathering ◽  
Surveillance Period ◽  
Saint Louis ◽  
Ed Visits

ObjectiveTo describe a novel application of ESSENCE by the Saint Louis County Department of Public Health (DPH) in preparation for a mass gathering and to encourage discussion about the appropriateness of sharing syndromic surveillance data with law enforcement partners.IntroductionIn preparation for mass gathering events, DPH conducts enhanced syndromic surveillance activities to detect potential cases of anthrax, tularemia, plague, and other potentially bioterrorism-related communicable diseases. While preparing for Saint Louis to host a Presidential Debate on October 9, 2016, DPH was asked by a partner organization whether we could also detect emergency department (ED) visits for injuries (e.g., burns to the hands or forearms) that could possibly indicate bomb-making activities.MethodsUsing the Electronic Surveillance System for the Notification of Community-Based Epidemics (ESSENCE), version 1.9, DPH developed a simple query to detect visits to EDs in Saint Louis City or Saint Louis County with chief complaints including the word “burn” and either “hand” or “arm.” A DPH epidemiologist reviewed the results of the query daily for two weeks before and after the debate (i.e., from September 25, 2016 to October 23, 2016). If any single ED visit was thought to be “suspicious” – if, for example, the chief complaint mentioned an explosive or chemical mechanism of injury – then DPH would contact the ED for details and relay the resulting information to the county’s Emergency Operations Center.ResultsDuring the 29 day surveillance period, ESSENCE detected 27 ED visits related to arm or hand burns. The ESSENCE query returned a median of 1 ED visit per day (IQR 0 to 2 visits). Of these, one was deemed to merit further investigation – two days before the debate, a patient presented to an ED in Saint Louis County complaining of a burned hand. The patient’s chief complaint data also mentioned “explosion of unspecified explosive materials.” Upon investigation, DPH learned that the patient had been injured by a homemade sparkler bomb. Subsequently, law enforcement determined that the sparkler bomb had been made without any malicious intent.ConclusionsDPH succeeded in using ESSENCE to detect injuries related to bomb-making. However, this application of ESSENCE differs in at least two ways from more traditional uses of syndromic surveillance. First, conventional syndromic surveillance is designed to detect trends in ED visits resulting from an outbreak already in progress or a bioterrorist attack already carried out. In this case, syndromic surveillance was used to detect a single event that could be a prelude to an attack. The potential to prevent widespread injury or illness is a strength of this approach. Second, conventional syndromic surveillance identifies potential outbreak cases or, in the case of a bioterrorist attack, potential victims. In this case, syndromic surveillance was used to identify a potential perpetrator of an attack. While public health and law enforcement agencies would ideally coordinate their investigative efforts in the wake of an attack, this practice has led to conversations within DPH about the appropriateness of routinely sharing public health surveillance data with law enforcement. 

An Observational Study Using English Syndromic Surveillance Data Collected During the 2012 London Olympics – What did Syndromic Surveillance Show and What Can We Learn for Future Mass-gathering Events?

2016 ◽  
Vol 31 (6) ◽  
pp. 628-634 ◽  
Author(s):  
Dan Todkill ◽  
Helen E. Hughes ◽  
Alex J. Elliot ◽  
Roger A. Morbey ◽  
Obaghe Edeghere ◽  
...  
Keyword(s):  
Public Health ◽  
Observational Study ◽  
Real Time ◽  
Syndromic Surveillance ◽  
Olympic Games ◽  
Surveillance Data ◽  
Surveillance Systems ◽  
Mass Gathering ◽  
Opening Ceremony ◽  
London 2012

AbstractIntroductionIn preparation for the London 2012 Olympic Games, existing syndromic surveillance systems operating in England were expanded to include daily general practitioner (GP) out-of-hours (OOH) contacts and emergency department (ED) attendances at sentinel sites (the GP OOH and ED syndromic surveillance systems: GPOOHS and EDSSS).Hypothesis/ProblemThe further development of syndromic surveillance systems in time for the London 2012 Olympic Games provided a unique opportunity to investigate the impact of a large mass-gathering event on public health and health services as monitored in near real-time by syndromic surveillance of GP OOH contacts and ED attendances. This can, in turn, aid the planning of future events.MethodsThe EDSSS and GPOOHS data for London and England from July 13 to August 26, 2012, and a similar period in 2013, were divided into three distinct time periods: pre-Olympic period (July 13-26, 2012); Olympic period (July 27 to August 12); and post-Olympic period (August 13-26, 2012). Time series of selected syndromic indicators in 2012 and 2013 were plotted, compared, and risk assessed by members of the Real-time Syndromic Surveillance Team (ReSST) in Public Health England (PHE). Student’s t test was used to test any identified changes in pattern of attendance.ResultsVery few differences were found between years or between the weeks which preceded and followed the Olympics. One significant exception was noted: a statistically significant increase (P value = .0003) in attendances for “chemicals, poisons, and overdoses, including alcohol” and “acute alcohol intoxication” were observed in London EDs coinciding with the timing of the Olympic opening ceremony (9:00 pm July 27, 2012 to 01:00 am July 28, 2012).ConclusionsSyndromic surveillance was able to provide near to real-time monitoring and could identify hourly changes in patterns of presentation during the London 2012 Olympic Games. Reassurance can be provided to planners of future mass-gathering events that there was no discernible impact in overall attendances to sentinel EDs or GP OOH services in the host country. The increase in attendances for alcohol-related causes during the opening ceremony, however, may provide an opportunity for future public health interventions.TodkillD, HughesHE, ElliotAJ, MorbeyRA, EdeghereO, HarcourtS, HughesT, EndericksT, McCloskeyB, CatchpoleM, IbbotsonS, SmithG. An observational study using English syndromic surveillance data collected during the 2012 London Olympics – what did syndromic surveillance show and what can we learn for future mass-gathering events?Prehosp Disaster Med. 2016;31(6):628–634.

scholarly journals (A225) Lessons Learned at the Commonwealth Games: A Mass-Gathering Sporting Event in New Delhi, India

2011 ◽  
Vol 26 (S1) ◽  
pp. s61-s61
Author(s):  
A. Madan
Keyword(s):  
Public Health ◽  
Mass Casualty ◽  
Lessons Learned ◽  
Mitigation Strategies ◽  
New Delhi ◽  
Sporting Events ◽  
Mass Gathering ◽  
Outbreak Response ◽  
Mass Gatherings ◽  
Commonwealth Games

Mass gatherings can be religious, political, socio-cultural, or sporting events, and vary in the form of processions, car races, conferences, fairs, etc. New Delhi hosted the 2010 Commonwealth Games, a mass gathering spread over a duration of 10 days with different venues and a high density of participants, spectators, security personnel, volunteers, and high-profile guests. Various organizations were involved in the planning and implementation of the games which called for a collaborative and coordinated effort to make the event a success. Security coverage was required for 23 sporting, 32 training, and seven non-sporting venues. Security arrangements were of utmost importance and required training, mobilization, and deployment of army, police, and other emergency workers, as well as establishing Standard Operating Procedures for responses to chemical, biological, radioactive, and nuclear events and availing specialized equipment. Areas of public health interventions in mass gathering include mass-casualty preparedness, disease surveillance and outbreak response, safety of water, food, and venues, health promotion, public health preparedness and response, pest and vector control, coordination and communication, healthcare facility capacity, and medical supplies. Methods adopted for the study included interviews with the stakeholders of the Commonwealth Games and use of secondary data to cite examples and support arguments. Existing knowledge must be documented and made available for use in planning for future mass gatherings. The size, duration, and interest of such events demands special attention toward preparedness and mitigation strategies to prevent or minimize the risk of ill health and maximizing the safety of people involved.

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 Adoption of Public Health Readiness Guidelines for Meaningful Use

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Eunice R. Santos ◽  
Wesley McNeely ◽  
Biru Yang ◽  
Raouf R. Arafat
Keyword(s):  
Public Health ◽  
Syndromic Surveillance ◽  
Gulf Coast ◽  
Meaningful Use ◽  
Health Department ◽  
Lessons Learned ◽  
Surveillance Systems ◽  
Syndromic Surveillance System ◽  
Related Data ◽  
Control And Prevention

ObjectiveTo describe the challenges and lessons learned for public healthand providers to successfully implement public health MeaningfulUse readiness guidelines and navigate from intent to submission ofproduction data while simultaneously upgrading surveillance systems.IntroductionThe Syndromic Surveillance Consortium of Southeast Texas(SSCSeT) consists of 13 stakeholders who represent 19 counties orjurisdictions in the Texas Gulf Coast region and receives health datafrom over 100 providers. The Houston Health Department (HHD)maintains and operates the syndromic surveillance system for the GulfCoast region since 2007. In preparation for Meaningful Use (MU) theHHD has adapted and implemented guidance and recommendationsfrom Centers for Disease Control and Prevention, Office of NationalCoordinator for Health Information Technology and others. HHDsgoal is to make it possible for providers meet MU specification byfacilitating the transmission of health related data for syndromicsurveillance. The timing of the transition into MU overlaps with thechange in syndromic surveillance systems.

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