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Update to 2010 State Influenza Coordinator’s ConferenceSession Two – New and Enhanced SurveillanceSunday June 6, 2010 - 3:00-3:15pm, Portland, OR
Distribute Project
Division of Healthcare Information (DHI) (proposed)Public Health Surveillance Program Office (proposed)Office of Surveillance, Epidemiology, & Laboratory Services (OSELS) (Proposed)Centers for Disease Control & Prevention (CDC)
Taha A. Kass-Hout, MD, MSDeputy Director for Information Science (Acting)
Disclaimer: The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of The Centers for Disease Control and Prevention.
Principles & Characteristics• Aggregates counts of ILI and total ED
visits from existing health dept ED-SS systems– Cross-tabulated by a limited number of
variables
• Allows flexibility in use of “chief complaint” (or ICD9) ILI Syndromic criteria that HDs had already developed
• Fosters “community of users”
A Brief History of Distribute• Proof-of-concept Phase (2006 to July 2009)
– Funding from CDC and Markle Foundation– Recruited nine sites in US and three internationally– Focused on establishing viability of approach
• Pandemic Phase (August 2009 to June 2010)– Expanded funding from CDC lead to CDC, PHII and
ISDS collaboration– Expanded from 10 to 34 sites (including 10
BioSense sites) in ~4months– Enhanced information systems, analyses– Strengthened community support
Current Status• ED Coverage Estimates
– 34 Health departments (~1,300 EDs) with 8 HDs ≥ 90% ED visit coverage
• Local ILI Syndrome Definitions– Narrow: attempts to replicate ILINet
definition, may exclude many with influenza due to brevity of CC recording
– Broad: less restrictive, yields parallel, higher amplitude signal
Current Jurisdictions
Information Pathways
Hospitals HD SS system
Hospitals HD SS system CDC BioSense*
Hospitals HD SS system
Hospitals CDC BioSense*Hospitals
* With HD approval
Via ISDS (UW)
Hospitals HD SS systemHospitals HD SS system Via CDC
Stratifying Variables
Temperature Disposition Age
6 8
34Number of Jurisdictions
Disposition (Admission) of ILI Pts
4/1
4/11
4/21 5/
15/
115/
215/
316/
106/
206/
307/
107/
207/
30 8/9
8/19
8/29 9/
89/
189/
2810
/810
/18
10/2
811
/711
/17
11/2
712
/712
/17
12/2
71/
61/
161/
26 2/5
2/15
2/25 3/
73/
173/
27 4/6
4/16
4/26 5/
65/
16
02468
1012141618
% o
f ILI
pat
ient
s ho
spita
lized
% o
f ED
vis
its b
y IL
I pat
ient
s w
ho w
ere
hosp
italiz
ed
% o
f ED
vis
its b
y IL
I pat
ient
sno
t hos
pita
lized
Week Ending
Yellow: ILI patients hospitalized ILI patients
Red: ILI patients hospitalized Total ED patients Green: ILI patients non-hospitalized Total ED patients
Source: BioSense
Public Site
Restricted(Contributor’s) Site
Online Data
http://ISDSDistribute.org
Comparison to ILINet• State-based
jurisdictions– Correlations ranged from
0.64 to 0.96 with mean and median of 0.83 and 0.83, respectively
• Local-based jurisdictions– Correlations ranged from
0.38 to 0.91 with mean and median of 0.76 and 0.81, respectively
• Visually, major peaks in % ILI in the 2 systems tracked well together
Community of Practice• Approximately 90 state and local
epidemiologists
• Representing 43 health departments
• Wide range of expertise in syndromic surveillance
Trade-Offs• Timeliness
– Possible to collect and display daily, HD-specific ILI data (2-3 day lag for most HDs, including censoring for dates with incomplete reporting)
– Instability of daily data: most recent 2-3 day “trends” not consistently born out by subsequent observations
• Flexibility in ILI syndrome criteria– Allowed by using criteria “validated” by state/local
flu surveillance experience– Variability in amplitude of signal precluded
comparisons of H1N1 impact or summary estimate of H1N1 ED visits
Next Steps• Identification of EDs participating in Distribute and
ILINet to prevent duplication
• Assignment of ED surveillance POC at health departments and collaboration with influenza coordinators
• ILINet and Distribute comparison– CSTE recommended continuing to display Distribute data
separate from ILI-Net (aka, co-visualize)
• Increase coverage (ongoing)
• Address variability in ILI criteria (aka “Harmonize” ILI criteria)
Acknowledgements• ISDS Staff and Volunteers• Public Health Informatics Institute (PHII)• Project liaisons from NACCHO/CSTE/ASTHO• Support to ISDS
– Tufts Health Care Institute (THCI)– Markle Foundation
• CDC:– NCIRD, Influenza Division– OSELS & former NCPHI – H1N1 response team– OPHPR
For more information please contact Centers for Disease Control and Prevention1600 Clifton Road NE, Atlanta, GA 30333Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: cdcinfo@cdc.gov Web: www.atsdr.cdc.gov
Thank You!
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