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CenterforSurveillance,Epidemiology,andLaboratoryServices
PublicHealthSurveillanceActivitiesattheDivisionofHealthInformaticsandSurveillance
MiguelH.Torres-Urquidy,DDS,MS,PhD(Candidate)SeniorServiceFellowConference:DentalPublicHealthInformatics:OpportunitiesinaChangingEnvironment
January19-20,2017
OUTLINE§ InformaticsActivitieswithintheNationalPublicHealthSurveillanceSystems
– NationalNotifiableDiseaseSurveillanceSystem
– NationalSyndromicSurveillanceProgram
Disclaimer:ThefindingsandconclusionsinthisreportarethoseoftheauthoranddonotnecessarilyrepresenttheofficialpositionoftheCentersforDiseaseControlandPrevention.
NationalNotifiableDiseasesSurveillanceSystem(NNDSS)
§ TheNationalNotifiableDiseasesSurveillanceSystem(NNDSS)isanationwidecollaborationthatenablesalllevelsofpublichealth—local,state,territorial,federal,andinternational—tosharenotifiabledisease-relatedhealthinformation.
NNDSS:Overview
§ Publichealthusesthisinformationtomonitor,control,andpreventtheoccurrenceandspreadofstate-reportableandnationallynotifiableinfectiousandnoninfectiousdiseasesandconditionsandoutbreaks.
NNDSS:Overview
§ NNDSSisamultifacetedprogramthatincludesthesurveillancesystemforcollection,analysis,andsharingofhealthdata.Italsoincludespolicies,laws,electronicmessagingstandards,people,partners,informationsystems,processes,andresourcesatthelocal,state,territorial,andnationallevels.
NNDSS:SupportingPublicHealthSurveillanceinJurisdictionsandatCDC
§ Notifiablediseasesurveillancebeginsattheleveloflocal,state,andterritorialpublichealthdepartments(alsoknownasjurisdictions).Jurisdictionallawsandregulationsmandatereportingofcasesofspecifiedinfectiousandnoninfectiousconditionstohealthdepartments.
NNDSS:SupportingPublicHealthSurveillanceinJurisdictionsandatCDC
§ Thehealthdepartmentsworkwithhealthcareproviders,laboratories,hospitals,andotherpartnerstoobtaintheinformationneededtomonitor,control,andpreventtheoccurrenceandspreadofthesehealthconditions.Inaddition,healthdepartmentsnotifyCDCabouttheoccurrenceofcertainconditions.
NNDSS:SupportingPublicHealthSurveillanceinJurisdictionsandatCDC
§ TheCDCDivisionofHealthInformaticsandSurveillance(DHIS)supportsNNDSSbyreceiving,securing,processing,andprovidingnationallynotifiableinfectious
§ diseasesdatatodisease-specificCDCprograms.DHISalsosupportslocal,state,andterritorialpublichealthdepartmentsinhelpingthemcollect,manage,andsubmitcasenotificationdatatoCDCforNNDSS.
NNDSS:SupportingPublicHealthSurveillanceinJurisdictionsandatCDC
§ DHISprovidesthissupportthroughfunding,healthinformationexchangestandardsandframeworks,electronichealth informationsystems,andtechnicalsupport
§ throughtheNNDSSwebsite,tools,andtraining.Together,DHISandtheCDCprogramsprepareannualsummariesofinfectiousandnoninfectiousdiseasesandconditions,whicharepublishedintheCDCMorbidityandMortalityWeeklyReport.
NNDSS:SupportingPublicHealthSurveillanceinJurisdictionsandatCDC
§ TheseprogramscollaboratewiththeCouncilofStateandTerritorialEpidemiologists(CSTE)todeterminewhichconditionsreportedtolocal,state,andterritorialpublichealthdepartmentsarenationallynotifiable.
§ TheCDCprograms,incollaborationwithsubjectmatterexpertsinCSTEandinhealthdepartments,determinewhatdataelementsareincludedinnationalnotifications.
NNDSS:DataCollectionandReporting
§ InorderforCDCtocollectandusepublichealthsurveillancedata,theNNDSSstaffworkscloselywithstateandlocalhealthdepartments;expertsfromotherCDCprograms;
§ andpartners,suchastheCouncilofStateandTerritorialEpidemiologists(CSTE).Together,theydevelopandimplementconsistentstandards,tools,training,andtechnologytohelpensurethatdiseasereportingsystemsareintegratedwithineachstate.
NNDSS:DataCollectionandReporting
§ TheyalsohelpmakesurethatpublichealthsurveillancesystemsareinteroperablewithpublichealthsurveillancesystemsatCDCandotherstateandlocalhealth
§ departments,aswellaswithhealthITsystemsusedbyhospitals,laboratories,andprivateproviders.
NNDSS:DataCollectionandReporting
§ NNDSSprovidesNationalElectronicDiseaseSurveillanceSystem(NEDSS)standards,tools,andresourcestosupportreportingjurisdictions–state,local,territorial,andtribal
§ healthdepartments– tohelpthemimplementintegratedandinteroperablepublichealthsurveillancesystems.
NNDSS:NotifiableDiseaseSurveillanceStartsatStateandLocalLevels
§ CDCreceivescasenotificationsfrom57reportingjurisdictions.Eachstatehaslawsrequiringcertaindiseasesbereportedatthestatelevel,butitisvoluntaryforstatestoprovide
§ informationornotificationstoCDCatthefederallevel.
NNDSS:NotifiableDiseaseSurveillanceStartsatStateandLocalLevels
§ Thenotifiablediseasesdatavoluntarilysharedbythese57jurisdictionsrepresentsasmallportionofthepublichealthsurveillancedatathatjurisdictions
§ collectandusetomakedecisionsandconductpublichealthactivitiesintheircommunities(e.g.,outbreakdetectionandcontrol).Thereareseveralimportantdistinctionsbetweenareportablediseaseandanotifiabledisease.
NNDSS:NotifiableDiseaseSurveillanceStartsatStateandLocalLevels
§ Itismandatorythatreportablediseasecasesbereportedtostateandterritorialjurisdictionswhenidentifiedbyahealthprovider,hospital,orlaboratory.Thistypeof
§ requiredreportingusespersonalidentifiersandenablesthestatestoidentifycaseswhereimmediatediseasecontrolandpreventionisneeded.Eachstatehasitsownlawsandregulationsdefiningwhatdiseasesarereportable.Thelistofreportablediseasesvariesamongstatesandovertime.
NNDSS:NotifiableDiseaseSurveillanceStartsatStateandLocalLevels
§ Itisvoluntarythatnotifiable diseasecasesbereportedtoCDCbystateandterritorialjurisdictions(withoutdirectpersonalidentifiers)fornationwideaggregationandmonitoringof§ diseasedata.Regular,frequent,timelyinformationonindividualcasesisconsiderednecessarytomonitordiseasetrends,identifypopulationsorgeographicareasathighrisk,formulateandassesspreventionandcontrolstrategies,andformulatepublichealthpolicies.
NNDSS:NotifiableDiseaseSurveillanceStartsatStateandLocalLevels
§ Thelistofnotifiablediseasesvariesovertimeandbystate.ThelistofnationallynotifiablediseasesisreviewedandmodifiedannuallybytheCSTEandCDC.Everynationally
§ notifiablediseaseisnotnecessarilyreportableineachstate.
NNDSS:CaseDefinitions
§ Acasedefinitionissetofuniformcriteriausedtodefineadiseaseforpublichealthsurveillance.Casedefinitionsenablepublichealthtoclassifyandcountcasesconsistently
§ acrossreportingjurisdictions,andshouldnotbeusedbyhealthcareproviderstodeterminehowtomeetanindividualpatient’shealthneeds.
NNDSS:CaseDefinitions
§ Whilethelistofreportableconditionsvariesbystate,theCouncilofStateandTerritorialEpidemiologists(CSTE)hasrecommendedthatstatehealthdepartmentsreportcasesofselected
§ diseasestoCDC’sNationalNotifiableDiseasesSurveillanceSystem(NNDSS).Everyyear,casedefinitionsareupdatedusingCSTE’sPositionStatements.Theyprovideuniformcriteriaofnationallynotifiableinfectiousandnon-infectiousconditionsforreportingpurposes.
NNDSS:ProvisionalData
§ Provisionaldata areinitiallycollectedlocallyasaresultofstate,territorial,andlocallegislationandregulationsthatrequirehealthcare
§ providers,medicallaboratories,andotherentitiestosubmitdataonreportableconditionstostateandlocalpublichealthdepartments.Thereportableconditionsvarydependinguponeachjurisdiction’shealthpriorities.
NNDSS:ProvisionalData
§ ThereportingjurisdictionsvoluntarilysubmitcasenotificationsforthenationallynotifiableconditionstoCDC.NNDSSdataare
§ consideredprovisionalandsubjecttochangeeachweekuntilthedataarereconciledandverifiedwiththestateandterritorialdataproviderstobethefinalofficialincidencecountsforagivennotifiableconditionandyear.
NNDSS:ProvisionalData
§ Cumulativecountsofcasespresentedeachweekcanincreaseordecreaseasadditionalinformationbecomesavailableand
§ countsareupdated.Inanygivenyear,formostconditions,cumulativeprovisionalcasecountsandratesdonotmatchfinalizedcasecountsandrates.
NNDSS:FinalizedData
§ Finalizeddata arecreatedwithinapproximatelysixmonthsaftertheendofthecalendaryear.CDCfinalizesNNDSSdataincollaboration
§ withthestateandterritorialhealthdepartmentdataprovidersandCDCprogramleadersforeachnotifiablecondition.
NNDSS:FinalizedData
§ FinalizedcountsbyconditionandreportingjurisdictionarepublishedintheMMWR EarlyReleaseTableapproximatelytwomonthsafterthe
§ stateandterritorialhealthdepartmentsfinalizethedata.Inaddition,finalizeddataarepublishedintheMMWRSummaryofNotifiableInfectionsDiseasesandConditions—UnitedStates (alsoreferredtoastheSummary)approximatelyoneyearafterthedataarepublishedintheEarlyReleaseTables.
NNDSS:FinalizedData
§ TheNNDSSsurveillancedatalikelyrepresentanunderestimateofthetruenumberofcasesofagivenconditionbecauseofunder-
§ recognitionandunder-reportingofdisease.
NNDSS:ProvisionalData
Accessibleat:§ Data.cdc.gov§ CDCWONDER§ MMWRWeekly:referto"Notifiable
DiseasesandMortalityTables"
NNDSS:FinalizedData
§ SummaryofNotifiableInfectiousDiseasesandConditions*MMWR:https://www.cdc.gov/mmwr/mmwr_nd/index.html
§ SummaryofNotifiableNon-InfectiousDiseaseandConditionsMMWR:https://www.cdc.gov/mmwr/mmwr_nnc/index.html
*Onlydatafromreportingstates,territories,andjurisdictionsthatdesignatedtheinfectiousdiseaseorconditionasreportableareincludedinthesummarytables.
NationalSyndromicSurveillanceProgram(NSSP)
§ NSSPOverview§ TheNationalSyndromic
SurveillanceProgram(NSSP)promotesandadvancesdevelopmentofasyndromicsurveillancesystemforthetimelyexchangeofsyndromicdata.
NationalSyndromicSurveillanceProgram(NSSP)
§ NSSPOverview§ Thesedataareusedtoimprove
nationwidesituationalawarenessandenhanceresponsivenesstohazardouseventsanddiseaseoutbreakstoprotectAmerica’shealth,safety,andsecurity.
NationalSyndromicSurveillanceProgram(NSSP)
§ NSSPOverview§ NSSPfunctionsthroughcollaboration
amongindividualsandorganizationsatlocal,state,andfederallevelsofpublichealth;federalagenciesincludingtheU.S.DepartmentofDefenseandtheU.S.DepartmentofVeteransAffairs;publichealthpartnerorganizations;andhospitalsandhealthprofessionals.
NationalSyndromicSurveillanceProgram(NSSP)
§ NSSPFeatures§ TheBioSense Platform§ CommunityofPractice
NSSP:TheBioSense Platform
§ Tosupportnationalemergencypreparedness,theU.S.CongresspassedlegislationandappropriatedfundingtotheCentersforDiseaseControlandPrevention(CDC)toestablishanintegratednationalpublichealthsurveillancesystemforearlydetectionandrapidassessmentofbioterrorism-relatedevents.
NSSP:TheBioSense Platform
§ Tomeetthisneed,CDClaunchedBioSense in2003.Since2011,thefocushasexpandedtosituationalawarenessforall-hazardspreparednessandresponse.TheNSSPprovidessyndromicsurveillancepractitionersaccess
§ toanduseofthecloud-basedBioSense Platform,asecureintegratedelectronichealthinformationsystemwithstandardizedanalytictoolsandprocesses.
NSSP:CommunityofPracticeandCollaborationwithPartners§ NSSPpromotesaCommunityof
Practiceinwhichparticipantscollaboratetoadvancethescienceandpracticeofsyndromicsurveillance.TheNSSPCommunityofPracticeincludesCDC-fundedgrantees,nonfunded states
§ andjurisdictionsthatcontributedatatotheBioSense Platform,publichealthpractitionerswhouselocalsyndromicsurveillancesystems,CDCprograms,otherfederalagencies,partnerorganizations,hospitals,healthcareprofessionals,andacademicinstitutions.
NSSP:CommunityofPracticeandCollaborationwithPartners§ CDCworkswithpartnerstoimprovethe
timelinessandrepresentativenessofthedatathatdrivedecisionmakingandaction.CDCfundstheAssociationofStateandTerritorialHealthOfficials(ASTHO)tohosttheBioSense Platform.
§ ThroughcoordinationwithpartnerssuchasASTHO,theCouncilofStateandTerritorialEpidemiologists,theNationalAssociationofCountyandCityHealthOfficials,andtheInternationalSocietyforDiseaseSurveillance,BioSense PlatformusersprovidefeedbackondevelopmentanduseoftheBioSense Platform.
NSSP:SyndromicSurveillance
§ Syndromicsurveillanceusessyndromicdataandstatisticaltoolstodetect,monitor,andcharacterizeunusualactivityforfurtherpublichealthinvestigationorresponse.
§ Syndromicdataincludepatientencounterdatafromemergencydepartments,urgentcare,ambulatorycare,andinpatienthealthcaresettings,aswellaspharmacyandlaboratorydata.
NSSP:SyndromicSurveillance
§ Thoughthesedataarebeingcapturedfordifferentpurposes,theyaremonitoredinnearreal-timeaspotentialindicatorsofanevent,adisease,oranoutbreakofpublichealthsignificance.Publichealth
§ practitionersusevarioussurveillancesystemsanddatasourcesincombinationwithsyndromicdatatoenhancetheirunderstandingofevents.
NSSP:SyndromicSurveillance
§ Otherdatasourcesthatprovidecontextmayincludeschoolandbusinessabsenteedata,poisoncontrolreports,andevensocialmediadatathatmaypresentanemergentpictureofpublichealthevents.
NSSP:PublicHealthSyndromicSurveillanceDataFlow
NSSP:SyndromicDatainAction
§ Syndromicsurveillancecanimprovepublichealthsituationalawarenessbymonitoringdifferentconditions
§ Infectiousdiseaseoutbreaksandpandemics(EnterovirusD68,influenza,H1N1fluvirus,Norovirus,Zika)
§ Identificationofreportableconditionsnotfoundbyothersystems(Ciguaterafishpoisoning)
NSSP:SyndromicDatainAction
§ Syndromicsurveillancecanimprovepublichealthsituationalawarenessbymonitoringdifferentconditions
§ Massgatherings(SuperBowl,conventions)
§ Naturalandman-madedisasters§ Injury(falls,bicycle-relatedinjuries,
drownings,drugoverdoses)§ Chronicconditions(asthma)
NSSP:SyndromicDatainAction
§ Syndromicsurveillancecanimprovepublichealthsituationalawarenessbymonitoringdifferentconditions
§ Healthcareuse(oralhealth,medicationrefills)• Burkom H,Burrer S,BarkerL,RobisonV,HicksP,Ising A.Useof
SyndromicDatatoDetermineOralHealthVisitBurdenonEmergencyDepartments.OnlineJournalofPublicHealthInformatics.2013;5(1):e57.
• Torres-UrquidyMH,Wallstrom G,Schleyer TKL.DetectionofDiseaseOutbreaksbytheUseofOralManifestations.JournalofDentalResearch.2009;88(1):89-94.
Questions!
Contact:MiguelTorres-UrquidyDDS,MS,PhD(Candidate)[email protected]
SeniorServiceFellowDivisionofHealthInformaticsandSurveillanceInformaticsServicesBranchDivisionofHealthInformaticsandSurveillanceCenterforSurveillance,Epidemiology,andLaboratoryServicesOfficeofPublicHealthScientificServicesCentersforDiseaseControlandPrevention(CDC)
Formoreinformation,contactCDC1-800-CDC-INFO(232-4636)TTY:1-888-232-6348www.cdc.gov
ThefindingsandconclusionsinthisreportarethoseoftheauthorsanddonotnecessarilyrepresenttheofficialpositionoftheCentersforDiseaseControlandPrevention.