BioSense
Public Health Surveillance Through Collaboration
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INFLUENZA SURVEILLANCE
IN SAN DIEGO COUNTY
Jeffrey Johnson, MPH
Senior Epidemiologist
Epidemiology & Immunization Services Branch (EISB)
Public Health Services
BioSense
Public Health Surveillance Through Collaboration
https://biosen.se
Influenza Detection & Surveillance
World
California
U.S.
San Diego
County
BioSense
Public Health Surveillance Through Collaboration
https://biosen.se
Influenza in the local news – January 2013
Source: UT San Diego
BioSense
Public Health Surveillance Through Collaboration
https://biosen.se
San Diego County
Influenza Surveillance
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All year round
Influenza lab result reporting
Sentinel sites: rapid flu tests and ILI
Influenza death reporting and tracking
Syndromic surveillance ILI (local system & BioSense)
EMS transports (local system)
911 calls (Firstwatch)
P&I deaths trends
Collaborative information sources
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Navy, CA & CDC Border Health, Mexico, social media
Distribution of reports, alerts, etc.
BioSense
Public Health Surveillance Through Collaboration
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San Diego County
Reports & Updates
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Weekly Influenza Watch report e-mailed to interested people
Regular alerts and updates through CAHAN (California Health Alert
Network)
Information used in county reports and press releases
BioSense
Public Health Surveillance Through Collaboration
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Community
Awareness
&
Circulating Virus
INFLUMATICS
Absenteeism
Progressing
Illness
Outpatient &
Hospitalization
Death
Influenza Surveillance Data Sources
• Baseline trends
• School
• New incidents
• Work
• Vaccinations
• Staffing levels
• Flu strains
• Healthcare capacity
• Situational awareness
• Animal influenza
• ILI
• Self-medicating
• Self-monitoring
• Nurse hotline
• 911 calls
• EMS transports
• Clinic
• Urgent care
• ED visits
• ICU cases
• Clinical Dx
• Lab tests
• Prescriptions
• Death
certificates
• Autopsy
BioSense
Public Health Surveillance Through Collaboration
https://biosen.se
Are we speaking
the same ILI language?
BioSense
Public Health Surveillance Through Collaboration
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ILI Surveillance in San Diego County
Indicator
Clinical
reporting
Frequency
Weekly
Data Source
Criteria
Notes
Review of ED
records
URI or ARI
with specific
temp
Person based
Emergency Daily
Department
Local syndromic
system
C.C. Text
parsing
Electronic
system
Paramedic
transports
Daily & Real
time
Local EMS system
Paramedic
impressions
Electronic
system
911 calls
Daily & Real
time
FirstWatch
911 call
complaints
Electronic
system
BioSense
Weekly
BioSense 2.0
C.C. & ICD9
Electronic
system
Sentinel
Weekly
testing sites
Sentinel testing sites Visit
+ rapid flu test & ILI complaint
Person based
MU-ILI
Meaningful Use ILI
Under
development
TBD
Text & temp
BioSense
Public Health Surveillance Through Collaboration
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San Diego County
ED Syndromic Surveillance ILI
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Emergency department data
Chief complaints
Syndrome categories
 Respiratory
 ED Flu like
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Text parsing
 A chief complaint must contain both a “respiratory” and “fever”
component
 Many different text options possible
BioSense
Public Health Surveillance Through Collaboration
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San Diego County
ED Syndromic Surveillance ILI cont.
Example text parsing into ILI
•“flu symptoms”
•“URI with fever”
•“coughing with fever”
•“487.1”
•“runny nose with fever”
•“h/a, cold with fever”
BioSense
Public Health Surveillance Through Collaboration
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BioSense
Public Health Surveillance Through Collaboration
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vs.
Clinician Reporting of ILI
Figure 1. Percent of Emergency
Department Visits for ILI by Week and FY
18
16
14
12
% ILI
10
8
6
4
2
0
27 30 33 36 39 42 45 48 51 1
Week #
2009-10
2010-11
2011-12
4
7 10 13 16 19 22 25
2012-13
2013-14
Syndromic Surveillance
BioSense
Public Health Surveillance Through Collaboration
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BioSense 2.0 ILI Trends, 2012–13FY
Selected ILI for SD (only), all visits, 7/1/2012 to 6/29/13 (weeks 27–26)
BioSense
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Initial Results x Day
BioSense
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Basic Comparison of BioSense ILI vs. Local Syndromic Surveillance
BioSense 2.0
Local Syndromic ILI
BioSense
Public Health Surveillance Through Collaboration
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What about Meaningful Use Data?
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HL7 messages – ADT A01, A03, A04, A05, A08
OBX segment contains the temperature
Demographics
MSH|^~\&|EPIC|…....
EVN|A03|20131023143659|……..
Emergency department
….
discharge diagnosis of an 8
….
year old with a
PV1|1|EMERGENCY|………
temperature of 104.2 and
OBX|1|……..
diagnosis of influenza
OBX|2|………
OBX|3|NM|MUPTAGE|3|8||||||F
OBX|4|NM|MUPTTEMP|4|104.2||||||F
DG1|1|ICD-9-CM|487.1^Influenza with other respiratory manifestations^ICD-9-CM|…
06/26/2013
BioSense
Public Health Surveillance Through Collaboration
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San Diego County Syndromic Surveillance Data Flow
06/26/2013
Atlas
Hospitals
Development
Corp
County contracted
messages broker
San Diego
Health
Connect HIE
Legend
SFTP ASCII Files
HL7 2.3 (Kaiser)
SDHC HIE HL7 2.5
SDHC HIE HL7 2.5 (in progress)
From BioSense
To BioSense (county aggregate)
CDC
Public Health
Services
Syndromic Surveillance
BioSense
Public Health Surveillance Through Collaboration
https://biosen.se
Concluding Thoughts
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ILI is a common population health indicator
ILI can apply to many different data sources
ILI, by definition, is hard to standardize
ILI is one of several key influenza surveillance components
ILI can be useful for surge capacity benchmarks
Syndromic MU-ILI data may have greater specificity and
standardization potential
BioSense
Public Health Surveillance Through Collaboration
https://biosen.se
THANK YOU
For More Information
Jeffrey Johnson
Jeffrey.johnson@sdcounty.ca.gov
619-692-8448