Lauren Lewis, MD, MPH Health Studies Branch Environmental Hazards and Health Effects National Center for Environmental Health Centers for Disease Control and Prevention Improving Disaster Surveillance: An Environmental Epidemiology Perspective

Health Studies Branch(HSB) Disaster Epidemiology and Response  Types of disasters  Natural (extreme weather events)  Technological (chemical and radiologic events)  Complex emergencies  Focus: epidemiologic support to state and local public health  Accurate data for public health decision-making

Hurricane Sandy 2012 American Samoa Tsunami Deepwater Horizon Oil Spill National Heat Wave 2012

Types of Epidemiologic Activities  Public health surveillance  Track illness, injury and death  Identify outbreaks  Syndromic, laboratory, morbidity, mortality  Rapid needs assessments  Identify shelter, community and health care needs to allocate resources  CASPER  Program evaluations  Assess success and identify barriers to improve response efforts  Epidemiologic research  Identify risk/protective factors for injury, illness and death Case-control, cohort, outbreak investigations, case series

Utility of Epidemiologic Data Justify and target resources Improve mitigation strategies to prevent future illness and death Provide situational awareness Guide individual, community and PH preparedness Prepared- ness Response Recovery Mitigation # deaths and illnesses, identify vulnerable pop or acute threats Estimate unmet infrastructure and health care needs Identify risk and protective factors Evaluate interventions Surveillance Rapid needs assessments Program evaluations Epidemiologic research

Why Conduct Disaster Surveillance?  Provide situational awareness  Track morbidity and mortality  Detect disease outbreaks  Determine action items such as resource allocation  Target interventions  Facilitate future disaster planning

Data Flow Mortality ME/coroners Hospitals Nursing home Funeral home DMORT office ARC Public Health County Region State Emergency Operations/ IMS Morbidity Hospitals Clinics Shelters Service delivery sites CDC Other States Report Data

Current HSB Disaster Surveillance Activities  Build capacity  Provide surveillance tools and training  Provide technical assistance during disasters  Conduct surveillance  Partner with American Red Cross (ARC) and poison centers  Utilize National Poison Data System (NPDS)  Analyze data and disseminate findings  Evaluate surveillance efforts

Provide Surveillance Tools and Training  Provide standardized disaster surveillance forms  Includes morbidity and mortality  Modifiable for any type of disaster  Available at  Conduct disaster epidemiology training  Includes surveillance and CASPER

Conduct Surveillance with American Red Cross  Monitor and analyze ARC mortality reports  Facilitate morbidity surveillance in ARC shelters

Conduct Poison Center Surveillance  National Poison Data System (NPDS)  Monitors calls to poison centers from clinicians and the public  Provides national, near real-time surveillance data  Poison center utility during disasters  Track CO poisonings  Monitor public concern  Provide hotline support

Radiologic Disaster Surveillance  Enhanced NPDS to detect and monitor radiologic events  Developed a standardized data collection tool  Collect data at community reception centers  Multipurpose: surveillance, acute triage, and long-term follow-up  Available at  Exploring strategies to improve screening capacity

Disaster Surveillance Challenges  Absent baseline information  Denominator data difficult to obtain  Damaged healthcare infrastructure  Need for rapid information

Disaster Surveillance Challenges  Competing priorities  Data collection varies between states and events  No incentive to share data with CDC  No electronic mechanism for data sharing

Potential Strategies to Improve Disaster Surveillance  Develop surveillance guidance  Increase utilization of existing surveillance during disasters  Biosense, National Poison Data System (NPDS), American Red Cross data, Environmental Public Health Tracking (EPHT), State-based syndromic surveillance, NCHS mortality data  Explore the utility of nontraditional sources  Track internet and social media reports  Active mortality surveillance