syndromic surveillance in georgia: a grassroots approach february 22, 2006 erin l. murray karl...
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Syndromic SurveillanceSyndromic Surveillancein Georgia:in Georgia:
A Grassroots ApproachA Grassroots ApproachFebruary 22, 2006February 22, 2006
Erin L. MurrayKarl Soetebier
Georgia Division of Public Health
Overview
• Why
• How
• What
• Where
Bioterrorism – original purpose, too rare
Infectious
Diseases Outbreak
sSeasonal Trends
& Pandemic
Preparedness
Chronic Diseases (non-ID) Trends
and Epidemics
Syndromic Surveillance—WhySyndromic Surveillance—Why
Bio-
terror
Pandemic preparedness – to be proven
Non-ID trends – real role
Seasonal trends – real role
Outbreaks – real role, less common
• Utilize Health Districts
– Solicit interest from
facilities
– Maintain relationships
with data sources
– Monitor flags in their
districts
– Coordinate response
with facilities
Syndromic Surveillance—HowSyndromic Surveillance—How
Syndromic Surveillance from the Syndromic Surveillance from the State Perspective: HowState Perspective: How
Centralized approach• Health Districts compare local data to
other districts and state totals
• Web-based easy access (SendSS)
• Data sources▬Clinical first▬Combine clinical and non-clinical
Syndromic Surveillance from the Syndromic Surveillance from the State Perspective: WhatState Perspective: What
• Clinical – Hospital emergency departments
– Moving focus from chief complaint to text-based physician’s diagnoses
– EMS dispatches (FirstWatch®)– Urgent care centers– School clinic visits– Influenza sentinel providers
• Non-clinical– School and employee absenteeism– RODS
Syndromic Surveillance from the Syndromic Surveillance from the State Perspective: Where to focusState Perspective: Where to focus
Risk factors for Infectious Diseases Outbreaks• Tier 1: Athens, Atlanta, Augusta, Columbus,
Macon, Savannah– Population Size (>100,000 population)
– Population’s potential exposures – Participants of events (Temporary)– University students (Semi-permanent)– >10% foreign born persons (Perm.)
Additional Factors• Tier 2: Albany, Dalton, Gainesville, Rome,
Valdosta, Waycross– Animal Exposure
– Potential for zoonotic transmission
– Population’s potential exposures– International or interstate travelers (Temporary)– Seasonal workers, military recruits, university
students (Semi-permanent)
– Geographic coverage– North, south, east, west
State Perspective: Where State Perspective: Where continuedcontinued
• Pipeline of key actions
– State
– District
– Corresponding technical
components
Syndromic Surveillance—Syndromic Surveillance—How continuedHow continued
Desired Variables from Emergency Departments
1. Hospital Name
2. Unique patient ID
3. Triage Date
4. Triage Time
5. Race
6. Age
7. Sex
8. Zip code
9. Chief complaint
10.MD diagnosis
11. ICD-9
12.Acuity or Triage Score
13.Disposition
Who has access rights for data viewing?
Participants
Source of data (e.g., hospital), Districts, Multiple Districts (inter-District), State
Data viewed by
Individual data source
Aggregate for:
– District, Multiple Districts, State
Syndrome
Event Count
Syndrome Event Graph
Flag Summary
• Flags PLUS
• Raw Data
• Only shows current
Working Day
Drill Down to
Chief Complaint
Raw Data
for Specific Date
and Strata
GIS Data• Still under
development• Release March 2006• GA Map with Health
Districts and Counties• Spatial distribution of
data over time
Interpretation & Possible Public Health Response “Protocol”
• Confirm the validity of the alert• Alert hospital infection control practitioner (ICP) • ICP contacts ED to evaluate the alert• District contacts other like services• Determine if similar alerts• District/State look at other data sources• Determine if similar alerts• Discuss and decide upon actions
School Absenteeism and Nurse Visit Data in SendSS
School
Absentee
Counts
School
Absentee
Graph
Clinic Visit Survey Tool
School information
Student information
Reason for visit
Action taken
Sentinel Provider Data in SendSS
Contact InformationContact Information
Erin L. [email protected]
Karl [email protected]
Wendy [email protected]
Susan Temporado [email protected]