Syndromic Surveillance in Georgia: A Grassroots Approach February 22, 2006 Erin L. Murray Karl Soetebier Georgia Division of Public Health.

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]