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
Syndromic Surveillance—Why
Bioterrorism
– original purpose, too rare
Outbreaks
– real role, less common
Seasonal trends
– real role
Pandemic preparedness
– to be proven
Non-ID trends
– real role
Bioterror
Infectiou
s
Diseases
Outbreak
s
Seasonal Trends
& Pandemic
Preparedness
Chronic Diseases (non-ID)
Trends and Epidemics
Syndromic Surveillance—How
•
Utilize Health Districts
–
Solicit interest from
facilities
–
Maintain relationships
with data sources
–
Monitor flags in their
districts
–
Coordinate response
with facilities
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 textbased 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.)
State Perspective: Where
continued
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
Syndromic Surveillance—
How continued
• Pipeline of key actions
– State
– District
– Corresponding technical
components
Desired Variables from
Emergency Departments
1. Hospital Name
8. Zip code
2. Unique patient ID 9. Chief complaint
3. Triage Date
10. MD diagnosis
4. Triage Time
11. ICD-9
5. Race
12. Acuity or Triage Score
6. Age
13. Disposition
7. Sex
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
elmurray@dhr.state.ga.us
Karl Soetebier
ksoetebier@dhr.state.ga.us
Wendy Cameron
wpcameron@dhr.state.ga.us
Susan Temporado Cookson
stcookson@dhr.state.ga.us