Peer Review #1 of "Evaluation of a novel syndromic surveillance system for the detection of the 2007 melamine-related nephrotoxicosis foodborne outbreak in dogs and cats in the United States (v0.1)"

The 2007 nephrotoxicosis outbreak associated with melamine and cyanuric acid adulteration of pet foods in the United States sparked an urgent need for a nationwide companion animal surveillance program. In 2016, we introduced a syndromic surveillance system based on a novel epidemiological algorithm, the proportionate diagnostic outcome ratio (PDOR). The PDOR procedure was validated using simulated outbreaks of foodborne illness (i.e., aflatoxicosis and gastrointestinal illness) in dogs and cats. In this study, we further evaluated the PDOR procedure using the 2007 melamine-related outbreak of nephrotoxicosis. The performance of the PDOR procedure was assessed by the time to alert and positive predictive value (PPV). Electronic medical records of dogs and cats seen at networked primary care veterinary hospitals across the United States were retrieved from a centralized database. The data of four relevant syndromic components: elevated serum creatinine concentration, vomiting, anorexia, and lethargy from July 28, 2006 to May 31, 2007 were prospectively analyzed using the PDOR algorithm. The results showed that the alerts generated from the analysis of elevated serum creatinine concentration could have led to an early detection of this nephrotoxicosis foodborne outbreak and were well matched to the reported timeline of the outbreak. Additionally, we also observed variations in the performance of the PDOR procedure across age of animals and syndromic components, with the PPVs ranged from 0.61 to 1.0. Combined with the findings from previous evaluations using simulated outbreak scenarios, this study provided additional evidence that the PDOR procedure can be applied in syndromic surveillance to effectively and accurately detect various types of foodborne illness outbreaks in companion animals. However, the interpretations of and responses to alerts require an understanding of clinical veterinary medicine and relevant syndromic knowledge, and should not be based solely on quantitative measures.

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Increase in emergency department visits related to cannabis reported using syndromic surveillance system

European Journal of Public Health ◽

10.1093/eurpub/cky272 ◽

2019 ◽

Vol 29 (4) ◽

pp. 621-625 ◽

Cited By ~ 4

Author(s):

G N Noel ◽

A M Maghoo ◽

F F Franke ◽

G V Viudes ◽

P M Minodier

Keyword(s):

Emergency Department ◽

Surveillance System ◽

Syndromic Surveillance ◽

Age Groups ◽

The United States ◽

Cross Sectional Study ◽

Emergency Department Visits ◽

Cross Sectional ◽

Syndromic Surveillance System ◽

Icd 10

Abstract Background Cannabis is illegal in France but, as in many countries, legalization is under debate. In the United States, an increase of emergency department (ED) visits related to cannabis exposure (CE) in infants and adults was reported. In France, a retrospective observational study also suggested an increase of CE in children under 6 years old. This study only included toddlers and the data sources used did not allow repeated analysis for monitoring. Methods Our study aimed to evaluate the trend in visits for CE in ED in patients younger than 27 years old in Southern France. A cross-sectional study using the Electronic Emergency Department Abstracts (EEDA) included in the national Syndromic Surveillance System. CE visits were defined using International Classification of Disease (ICD-10). Results From 2009 to 2014, 16 EDs consistently reported EEDA with <5% missing diagnosis code. Seven hundred and ninety seven patients were admitted for CE including 49 (4.1%) children under 8 years old. From 2009–11 to 2012–14, the rate of CE visits increased significantly across all age groups. The highest increase was in the 8–14 years old (+144%; 1.85–4.51, P < 0.001) and was also significant in children under 8 (0.53–1.06; P = 0.02). Among children under 8, hospitalization rate (75.5% vs. 16.8%; P < 0.001) and intensive care unit admissions (4.1% vs. 0.1%; P < 0.001) were higher compared with patients older than 8 years. Conclusion These trends occurred despite cannabis remaining illegal. EEDA could be useful for monitoring CE in EDs.

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Framework for the Development of Response Protocols for Public Health Syndromic Surveillance Systems: Case Studies of 8 US States

Disaster Medicine and Public Health Preparedness ◽

10.1097/dmp.0b013e31819f4483 ◽

2009 ◽

Vol 3 (S1) ◽

pp. S29-S36 ◽

Cited By ~ 17

Author(s):

Lori Uscher-Pines ◽

Corey L. Farrell ◽

Steven M. Babin ◽

Jacqueline Cattani ◽

Charlotte A. Gaydos ◽

...

Keyword(s):

Public Health ◽

Surveillance System ◽

Syndromic Surveillance ◽

The United States ◽

Essential Elements ◽

System Response ◽

Surveillance Systems ◽

Health Departments ◽

Public Health Response ◽

Syndromic Surveillance System

ABSTRACTObjectives: To describe current syndromic surveillance system response protocols in health departments from 8 diverse states in the United States and to develop a framework for health departments to use as a guide in initial design and/or enhancement of response protocols.Methods: Case study design that incorporated in-depth interviews with health department staff, textual analysis of response plans, and a Delphi survey of syndromic surveillance response experts.Results: All 8 states and 30 of the 33 eligible health departments agreed to participate (91% response rate). Fewer than half (48%) of surveyed health departments had a written response protocol, and health departments reported conducting in-depth investigations on fewer than 15% of syndromic surveillance alerts. A convened panel of experts identified 32 essential elements for inclusion in public health protocols for response to syndromic surveillance system alerts.Conclusions: Because of the lack of guidance, limited resources for development of response protocols, and few examples of syndromic surveillance detecting previously unknown events of public health significance, health departments have not prioritized the development and refinement of response protocols. Systems alone, however, are not effective without an organized public health response. The framework proposed here can guide health departments in creating protocols that will be standardized, tested, and relevant given their goals with such systems. (Disaster Med Public Health Preparedness. 2009;3(Suppl 1):S29–S36)

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