1. Using Vaccine Preventable Disease Surveillance Indicators for Evaluation (of Reporting to CDC) Denise Woods-Stout Vaccine Preventable Disease Surveillance Co-Coordinator Communicable Disease Epidemiology Program Colorado Department of Public Health and Environment (CDPHE)

2. Vaccine Preventable Disease Surveillance Indicators, 1997-2004 The June 2006 CDC report reviewed indicators for Haemophilus influenzae (H flu), pertussis, measles, mumps and rubella Report included National Summary State Specific Summary

3. Surveillance Indicators for Haemophilus influenzae, Colorado, 1997-2004 Report Year Total Cases* Cases < 5 Years of Age % Complete for 3 Key Variables ¶ % of Cases <5 Years of Age with Serotype Testing % of Cases <5 Years of Age with Vaccine History 19972278210057 19982167010033 19991556460 20003313000 2001383000 2002354000 2003407000 2004445000 * Confirmed, and probable case status. ¶ Clinical case definition (e.g. specimen type), serotype, and vaccine history.

4. Denver Metro Area is an Emerging Infections Program (EIP) Site Active surveillance for H flu since July 2000 All isolates are typed at state lab and CDC Medical charts are reviewed for underlying conditions and vaccination records H flu data should be complete for the majority of Colorado cases

5. Surveillance Indicators for Haemophilus influenzae, Colorado, 1997-2004 Report Year Total Cases* Cases < 5 Years of Age % of Cases <5 Years of Age with Serotype Testing % of Cases <5 Years of Age with Vaccine History CDCCOCDCCO 1997 22710057 1998 21610033 1999 15560 2000 3313085077 2001 38301000 2002 3540100075 2003 40701000 2004 44501000 * Confirmed, and probable case status. ¶ Clinical case definition (e.g. specimen type), serotype, and vaccine history.

6. Where did the data go? Use your disease investigation skills Look at the chain of data transmission

7. Chain of Data Transmission Cases reported to state/local health department Cases entered into Colorado Electronic Disease Reporting System (CEDRS) Cases investigated by health dept.

8. Chain of Data Transmission Disease specific information entered into the Colorado Electronic Disease Reporting System (CEDRS) Data reported to CEDRS during past week are transformed into a National Electronic Telecommunications System for Surveillance (NETTS) compatible file File is sent electronically to CDC

9. Why are the H flu Data Missing? Check with your computer programmer or Information Technology (IT) staff Was the disease specific data extracted, transformed into a NETTS file, and sent to CDC?

10. What Went Wrong? H flu disease specific data was not extracted from CEDRS or transmitted to CDC Immunization Program H flu disease specific data was only transmitted to CDC Emerging Infections Program

11. Surveillance Indicators for Pertussis, Colorado, 1997-2004 Report Year # Cases* # Meeting Clinical Case Definition ¶ % of Clinically Compatible Cases with Lab Testing CDCCOCDCCO 1997 415 3833976366 1998 357 3263505557 1999 312 2813117677 2000 487 4734746965 2001 389 3843838372 2002 464 4554578774 2003 368 360361369 2004 1185 11261128175 * Confirmed and probable cases. ¶ Clinically compatible.

12. Testing of 2003 and 2004 Colorado Pertussis Cases CDC report indicates 1 – 3% of Colorado pertussis cases were tested State data shows 69 – 75% of Colorado pertussis cases were tested

13. What Happened? Pertussis disease specific data was transmitted to CDC Pertussis information was not transmitted properly There was a data shift, so PCR positive results were sent as “Not Done”

14. What is a Data Shift? When a field is transmitted using an incorrect number of spaces all the information after that field is shifted The information from that point forward is incorrect

15. Data Shift Examples 8-digit date is transmitted as a 5- or 6-digit date or vise a versa (02/27/2006 or 02/27/06 or 2/27/06) Date is transmitted with or without dividing slashes (02/27/06 or 022706) Unknown or unused dates are not accounted for with 99/99/99 placeholder Cough duration is transmitted as 2-digit number of days, not 3-digit (56 vs. 056)

16. One Pertussis Case ASCII Space Delimited Transmission M908062053721270910190000010051958071 10470152060203111299999000020537280102Y 02/03/06YNYN04/07/06N056YXNNN999NY302/ 27/0608999/99/9999YX02/27/06X02/27/06X02/ 27/0699/99/99P02/27/06YU99/99/9999/99/99 UU99/99/99UU99/99/99UU99/99/99UU99/99/99 UU99/99/99UU9903/01/0603/01/06NN99999999 99999999990916003 Highlighted: case number, dob, cough duration, date of first specimen, and PCR result

17. Surveillance Indicators for Pertussis Cases < 7 Years of Age, Colorado, 1997 - 2004 Year # Cases* < 7 Years of Age % of Cases < 7 Years of Age with Vaccine History CDCCOCDCCO 1997190191895 19981221252395 19991081151893 2000182 5798 2001115 5697 2002143 4797 20031121095199 20042642653398 * Confirmed and probable cases.

18. Differences in Pertussis Vaccine History Information 1997 - 2004 CDC data indicates only 8 to 57% of the Colorado pertussis cases < 7 years of age had complete vaccine histories State data indicates > 90% of the Colorado pertussis cases < 7 years of age had complete vaccine histories CDC and CDPHE were viewing completeness of vaccine history differently

19. What Constitutes a “Vaccine History”? Vaccinated = Yes or No (not Unknown) If vaccinated provide: Vaccine date(s) Vaccine type(s) - must be included to be considered complete for CDC 1997 – 2004 Surveillance Indicator Report

20. No Vaccine Type = Incomplete Vaccine History Review the source of your immunization information Is vaccine type clearly indicated on the immunization records? Colorado official Certificate of Immunization does not distinguish between DTP and DTaP

22. Surveillance Indicators for Measles, CO 1997 - 2004 Year# Cases* % Complete for 10 Variables ¶ % of Confirmed Cases that are Lab Confirmed CDCCOCDCCO 1997 1998 1999 2000 210NA0100 2001 2002 2003 2004 11080100 * Confirmed & Probable Cases. ¶ Clinical case definition, hospitalization, lab testing, vaccine info., report date, transmission setting, outbreak related, epi-linked, dob & onset.

23. Colorado Measles, Mumps and Rubella Cases Completed surveillance worksheets were mailed to CDC for each case CDPHE assumed CDC entered the data from the worksheets into NETSS CDC is not allowed to enter data into NETSS

24. Non-Electronic Data = No Data Only basic information was transmitted to CDC electronically by CDPHE for measles, mumps and rubella cases State electronic database did not include measles, mumps and rubella disease specific information All Colorado measles, mumps & rubella cases were incomplete according to the CDC report

25. Why No Electronic Data? Paying a programmer to write code for the small number of Colorado measles, mumps & rubella cases has not been a resource use priority

26. Colorado Measles, Mumps and Rubella Reported in Colorado 1997 – 2004: 3 Measles Cases 25 Mumps Cases 3 Rubella Cases

27. Colorado Measles, Mumps and Rubella CDC will be using the Surveillance Indicator Report in the state grant funding process Due to this and the recent mumps outbreak, CDPHE is revisiting the cost effectiveness of having computer code written to report measles, mumps and rubella electronically to CDC

28. Summary CDC will be using the Surveillance Indicator Report in the state grant funding process (Hopefully, future CDC Surveillance Indicator Reports will be more timely so problems may be corrected)

29. Summary Investigate your surveillance indicator report if it appears incorrect Determine the definition of the criteria CDC used in the report

30. Summary Consult your computer programmer or IT staff Check if disease specific data was captured and sent electronically to CDC

31. Summary Determine whether there was a data shift in the disease specific information sent to CDC Ensure there is disease specific information in your electronic database to send to CDC

32. Questions?