1. Staffing RODS in Ohio February 23 rd, 2006 Biosurveillance Information Exchange Working Group Rutgers University Piscataway, NJ Loren Shaffer, MPH Loren.Shaffer@odh.ohio.gov Early Event Surveillance Supervisor

2. Our Current Systems Real-time Outbreak and Disease Surveillance (RODS) System BioSense Influenza-like Illness Sentinel Providers School Absenteeism Wildlife Disease Surveillance Ohio Disease Reporting System Early Aberration Reporting System (EARS)

3. RODS Developed at the University of Pittsburgh Utilizes a hospital’s existing HL-7 socket to receive real- time data Interprets free-text chief complaint from emergency department registration database and groups into one of seven prodromes Collects information from retailers about sales of over-the- counter medications Provides immediate analysis for trends and anomalies suggestive of disease outbreaks Secure web access by users

4. HIPAA Export of data for public health surveillance is permitted (45 CFR 164.512) Prior written authorization of individual is not required (45 CFR 164.512)

6. End Users of RODS in Ohio Total = 174 –State Health Department = 6 –Local Health Department = 87 88 of 135 LHDs represented –Hospital = 77 –Other = 4

13. RODS Alerts February 2004 to February 2006 –310 unique alerts received Seasonal Elevation – 40% Outbreaks – 22% Data Errors – 9% No Cause Identified – 28% –53% handled at State level –47% forwarded to local epidemiologist

14. RODS Alerts and Reported Outbreaks in Ohio 2/1/2004- 2/1/2006 Date of RODS Alert SyndromeCountyOutbreak CauseNumber Ill Date Reported to ODH 12/24/2004RespiratoryStatewideCO Poisoning~50not reported 1/11/2005GastrointestinalFranklinNorovirus71/24/2005 1/11/2005GastrointestinalFranklinNorovirus32/16/2005 1/30/2005GastrointestinalMahoningNorovirus52/9/2005 3/3/2005GastrointestinalMahoningC perfringens43/14/2005 10/26/2005GastrointestinalPrebleNorovirus~30011/4/2005 11/23/2005RashJeffersonScabies5not reported 12/27/2005GastrointestinalMontgomeryCampylobacter31/30/2006 8/3/2005 8/4/2005 8/5/2005 Gastrointestinal Constitutional Gastrointestinal HamiltonCryptosporidiosis~7508/22/2005 1/9/2006ConstitutionalSciotoScromboid Poisoning31/30/2006 1/18/2006RespiratoryErieInfluenza-like Illness24not reported *Information about the number ill and date reported was obtained from the Ohio Disease Reporting System (ODRS)

15. What are we doing with RODS? Monitoring for patterns suggestive of an infectious disease outbreak Influenza surveillance study & efforts Retrospective outbreak study (improved specificity) Adaptation to animal-based sources for emerging infectious disease surveillance Real-time clinical data analysis Environmental surveillance Specialized investigations

16. Influenza

17. Influenza

19. P( ↑ Consitutional|Outbreak N)= x c P( ↑ Botulinic|Outbreak N)= x b P( ↑ Respiratory|Outbreak N)= x r P( ↑ GI|Outbreak N) = x g P( ↑ Hemorrhagic|Outbreak N)= x h P( ↑ Neurologic|Outbreak N)= x n P( ↑ Rash|Outbreak N)= x ra P( ↑ Thermometer|Outbreak N)= x t P( ↑ Cold Relief|Outbreak N)= x cr P( ↑ Lozenges|Outbreak N)= x l P( ↑ Chest Rubs|Outbreak N) = x chr P( ↑ Bronchial Remedies|Outbreak N)= x br P( ↑ Antifever|Outbreak N)= x a P( ↑ Other Categories|Outbreak N)= x OTC Sales ED Registrations Known Outbreak

20. Zoonotic Disease Surveillance Adapt RODS to … –Veterinary Diagnostics Laboratory Lab orders batched & transmitted via ftp Parsed into syndrome categories based on previous mapping of tests Spatial/temporal analysis at the ZIP code-level –Veterinary Clinic Reason for Visit field included Near real-time export via ftp Co-co classifier parses free text into syndrome category Spatial/temporal analysis at the ZIP code-level

21. Emergency Department Categorize Into Syndromes Daily Totals Higher Than Expected? Historical Models Alert Review Trends Chief Complaint and Patient Demographics In HL7 messages Daily Continuous Updated monthly Valid Alert? Initiate Response Areas for Attention & Assistance

22. Identified Needs User Training → 1:1 & Conference Workshops User Protocols → Developed Protocol Document User Support → 24/7 Coverage Pilot 24/7 Coverage → System Enhancement to Permit Alerts to Jurisdictions Advisory Group(s) → Expansion of ODRS Advisory Committee Integration with Other Surveillance Systems → Ongoing Evaluations and Study Projects Local Health Department Resources → ?

23. Questions? Loren Shaffer Loren.Shaffer@odh.ohio.gov 614-728-3343