Emergency Department-based Syndromic Surveillance: Outbreak Detection

Aaron Kite-Powell, MSAaron Kite-Powell, MSFlorida Department of HealthFlorida Department of Health

Bureau of EpidemiologyBureau of Epidemiology

International Society of Disease International Society of Disease Surveillance WebinarSurveillance Webinar

May 2009May 2009

Emergency Emergency Department-based Department-based

Syndromic Syndromic Surveillance: Surveillance:

Outbreak Detection Outbreak Detection

BackgroundBackground Florida Department of HealthFlorida Department of Health

Central offices located in TallahasseeCentral offices located in Tallahassee Bureau of EpidemiologyBureau of Epidemiology

67 County Health Departments (CHDs)67 County Health Departments (CHDs) 67 epidemiology sections/departments67 epidemiology sections/departments Reportable disease/conditions follow-upReportable disease/conditions follow-up Syndromic surveillanceSyndromic surveillance

Bureau of EpidemiologyBureau of Epidemiology Advisory role to CHDsAdvisory role to CHDs Manage data systemsManage data systems Routine analysis of dataRoutine analysis of data

BackgroundBackground Earlier Regional ImplementationsEarlier Regional Implementations

Miami-Dade County Region (ESSENCE)Miami-Dade County Region (ESSENCE) Hillsborough County Region (STARS)Hillsborough County Region (STARS) Duval County Region (BioDefend)Duval County Region (BioDefend)

State Level ImplementationState Level Implementation State syndromic surveillance workgroupState syndromic surveillance workgroup Invested resources in 2006Invested resources in 2006 Implemented ESSENCE in summer of 2007Implemented ESSENCE in summer of 2007 As of 5/2009: 109 hospitals sending data As of 5/2009: 109 hospitals sending data

every dayevery day Voluntary participationVoluntary participation Represents > 50% of all ED visits in FloridaRepresents > 50% of all ED visits in Florida

Routine MonitoringRoutine Monitoring Statewide monitoringStatewide monitoring

12,000-14,000 ER visits per day12,000-14,000 ER visits per day State level - daily review by one analystState level - daily review by one analyst CHD trainings CHD trainings improve data analysis at local improve data analysis at local

levellevel County-level monitoringCounty-level monitoring

28 counties with reporting hospitals28 counties with reporting hospitals No. of hospitals reporting per county ranges No. of hospitals reporting per county ranges

from 1–16from 1–16 County-level monitoring process varies widelyCounty-level monitoring process varies widely

Perceived value of the dataPerceived value of the data Resources, hospital relationships, and local protocolsResources, hospital relationships, and local protocols Level of trainingLevel of training

Expectations of ED-based Expectations of ED-based Syndromic SurveillanceSyndromic Surveillance

What do we expect from ED-based What do we expect from ED-based syndromic surveillance?syndromic surveillance? Situational awarenessSituational awareness Detect outbreaksDetect outbreaks

Large seasonal outbreaks (ILI, norovirus)?Large seasonal outbreaks (ILI, norovirus)? Smaller clusters of potentially related Smaller clusters of potentially related

patients?patients?

How can we better use existing How can we better use existing variables in ED data to improve variables in ED data to improve outbreak detection?outbreak detection?

South Florida Mass Migration South Florida Mass Migration Exercise: Broward CountyExercise: Broward County

Example 1: Large Outbreak Example 1: Large Outbreak (exercise)(exercise)

Example 1: Large Outbreak Example 1: Large Outbreak (exercise)(exercise)

South Florida Mass Migration South Florida Mass Migration Exercise: Broward Exercise: Broward CountyCounty

Example 1: Large Outbreak Example 1: Large Outbreak (exercise)(exercise)

South Florida Mass Migration South Florida Mass Migration Exercise: BrowardExercise: Broward CountyCounty

Example 2: Small Example 2: Small OutbreakOutbreak

Analysis did not produce an alert for the day, but a subset of patients was defined as an outbreak by the investigators. See line list on the next slide.

Hillsborough County GI outbreakHillsborough County GI outbreak

Example 2: Small Example 2: Small OutbreakOutbreak

Hillsborough County GI outbreakHillsborough County GI outbreak

Example 2: Small OutbreakExample 2: Small Outbreak

Hillsborough County GI outbreakHillsborough County GI outbreak

Example 3: Small Example 3: Small OutbreakOutbreak

Duval County GI OutbreakDuval County GI Outbreak

Example 3: Small Example 3: Small OutbreakOutbreak

Duval County GI OutbreakDuval County GI Outbreak

Example 3: Small Example 3: Small OutbreakOutbreak

Duval County GI OutbreakDuval County GI Outbreak

OpportunityOpportunity

Develop additional analyses that:Develop additional analyses that: Look for clustering by the time the Look for clustering by the time the

patients arrive at the ED.patients arrive at the ED. By hospitalBy hospital By patient zip codeBy patient zip code

End result could include:End result could include: Detection of smaller outbreaksDetection of smaller outbreaks Quantification of the “epi-eyeball..”Quantification of the “epi-eyeball..”

Questions?Questions?

Contact information:Contact information: Aaron Kite-PowellAaron Kite-Powell

[email protected][email protected] 850-245-4444 ext. 2638850-245-4444 ext. 2638