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

Overview Why How What Where

Bioterrorism – original purpose, too rare Infectiou s Diseases Outbreak s Seasonal Trends & Pandemic Preparedness Chronic Diseases (non-ID) Trends and Epidemics Syndromic 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—How

Syndromic Surveillance from the State 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 State 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 State 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 continued

Pipeline of key actions –State –District –Corresponding technical components Syndromic Surveillance— How 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 Information Erin L. Murray Karl Soetebier Wendy Cameron Susan Temporado Cookson