The following are instructions for public health officials and hospital users to conduct syndromic surveillance on influenza-like illnesses using ESSENCE v

Influenza-like Illness (ILI) The ILI subsyndrome case definition in ESSENCE is: – Keywords: flu, flulike, influenza OR – Fever + Cough OR – Fever + Sore throat. For your convenience, we suggest using this subsyndrome for ILI queries instead of using your own free text or combining syndromes and subsyndromes on your own. 2

Methods ESSENCE is a flexible system, so we have described three different ways of obtaining ILI data for your purposes. We have noted whether public health or hospital users may find each method more useful to help you select a method. 3

Method One: Daily ILI Total by County 4 This approach is most appropriate for public health officials.

Step 1. Select your data source as Emergency Room Data by Patient Location. Step 2. Choose your geography system as Region (this is equivalent to county). Step 3. Pick your region (county) of interest. Multiple selection is possible using the ‘Ctrl’ Key function. Step 4. Select your Medical Grouping System as ‘ChiefcomplaintSubsyndrome’. Step 5. Highlight ‘ILI’ for ChiefcomplaintSubsyndrome and the Age Group, Sex, and Date Range of your interest. 5

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8 ‘Data Details’ permits users to view the breakdown by Geography, Age Group, and Sex that they selected.

Method Two: Weekly Percent of ILI 9 Both public health and hospital users will find this option useful.

Percent of ILI The most accurate way to compare syndromic surveillance trends in your region (county) with the trends observed statewide is to use a rate. ‘Weekly Percent’ in the tool bar provides the percent (%) of ILI related visits in the ER in our specified time period. This simple rate can be broken down by year, geography and age group. 10 Number of ILI related ER visits in specified time period Total number of ER Visits in specified time period X 100 = Weekly % of ILI

Step 1. Select the Year, Category, Geography, and Age Group of your choice and then click ‘Show Graph’. NOTE: You must select at least one choice in each field to query successfully. Step 2. ‘Graph Option’ allows you to edit the label and layout of the graph, and ‘Save Graph’ enables you to save the data as.png or.jpg file that you can insert into any report. 11

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Method Three: ILI by Hospital Level This method may be more useful for hospital users or for public health officials who want to view data for hospitals in their jurisdiction. 13

Step 1. Select your data source as either ‘Percentage ER data by Hospital Location’ or ‘Emergency Room data by Hospital Location’. Step 2. You can choose either ‘hospitalregion’ or ‘hospital’ for the geography system. Step 3. For users who chose ‘hospital’ in previous step, now pick the hospital(s) of your interest. For those who chose ‘hospitalregion’, now pick the region(county) of hospital that you want. 14

1a.2a.3a.1b.2b.3b. 15 OR

Step 4. Select ‘Chiefcomplaintsubsyndromes’ for your Medical Grouping System. Step 5. Highlight ‘ILI’ for ChiefcomplaintSubsyndrome and the Age Group, Sex, and Date range of your interest. 17 NOTE: Either pathway A or B will lead you to Step 4. However the results you obtain in Step 6 through 8 will vary. The most accurate way to compare syndromic surveillance trends in your hospital (or hospital region) with the trends observed elsewhere is to use a rate. Therefore, for comparison purposes, we recommend ‘Percent ER Data by Hospital Location’ (pathway A) as your data source.

Step 6. Shows a graphical display of your data. ‘Graph Option’ allows you to edit the label and layout of the graph, and ‘Save Graph’ enables you to save the data as.png file that you can insert into any report. Step 7. Clicking on ‘Data Details’ permits users to view the breakdown by Geography, Age Group, and Sex that they selected. Step 8. Shows graphical display of the data stratified by demographic factors. 18 NOTE: Data results showed in the next two slides are for counts of ILI related visits (pathway B).

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20 ‘Data Details’ permits users to view the breakdown by Geography, Age Group, and Sex that they selected.

Interpretation of ILI ILI counts and rates can be important for both public health and hospital users to monitor ILI trends in their communities. We encourage you to consider other data sources when utilizing ESSENCE findings including: school absenteeism, local sentinel surveillance sites, lab orders or findings, etc. 21

Interpretation of ILI Local public health agencies may wish to use ESSENCE for assessing your vaccine security risk or other planning activities. The LPHA Vaccine Security Weekly Report (for authorized use only) utilizes statewide ESSENCE ILI data, however, you may want to view this report in the context of data from your own jurisdiction as well. 22

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