1. Syndromic Surveillance and The Health Alert Network Lex Gibson Epidemiologist Alleghany/Roanoke City Health Districts

2. Objectives Define and describe Syndromic Surveillance Define and describe the Health Alert Network (HAN) Discuss the benefits of utilizing HAN

3. What is surveillance? The ongoing and systematic –collection, –analysis, –interpretation, and –dissemination of health outcome data

4. Why conduct surveillance? Basis for action –Investigation –Control –Prevention Basis for Learning –Magnitude –Distribution –Evaluation –Planning and Analysis

5. Reportable Diseases Traditional method Legal authority Defined list of diseases Reporting by physicians and laboratories is required by law Typically requires a diagnosis Passive system

6. Reportable Diseases Added 12/01 CJD if < 55 years of age HBsAg positive pregnant women Hepatitis C, acute and chronic Q fever Smallpox Streptococcus pneumoniae, invasive if < 5 years of age Tularemia Unusual occurrence of disease of public health concern Viral hemorrhagic fever

7. Enhanced Surveillance Early Warning System –Timely –Trigger investigation and control Identify emerging infections or bioterrorist activities Use new technology and non-traditional data sources Meaningful, practical and efficient

8. Non-Traditional Data Sources 9-1-1 calls School absenteeism Over-the-counter drug sales Veterinarians Emergency Departments –Syndromic Surveillance

9. Syndromic Surveillance Historical Perspective –Developed by CDC –In place since 9/12/2001 –Conducted during WTO, RNC & DNC –Used during Presidential Inauguration 2001 Does Not Require Diagnosis Can be Manual or Electronic

10. Syndrome Categories Death Sepsis Rash Respiratory Gastrointestinal Unspecified Infection Neurological Other

11. Take Away Message Due to the threats that face us today, all forms of surveillance must be improved to enable a fast and appropriate public health response.

12. Early Detection Can Save Lives!

13. Syndromal Surveillance Systems EDIS- Currently used at Carilion BIOSENCE- under development by CDC ESSENCE –Developed by JHU –Currently a pilot program in certain Virginia localities –Soon to be offered statewide

14. ESSENCE Electronic Surveillance System for the Early Notification of Community-based Epidemics

15. Benefits of ESSENCE Automated Syndromic Surveillance Replace manual systems Allow greater analytic capability Access to additional data sources OTC, Military, Medical Claims, etc. Continuous support of JHU Maintain consistency with MD and DC

16. Where are we now? MOUs signed by many hospitals MOU signed with JHU Hardware and software have been purchased ESSENCE software installed on VDH server Receiving some data from hospitals Determined access levels for users

17. What Needs to be Done? IT perspective: –Receive and verify data from all hospitals –Complete security audit –Modify and evaluate ESSENCE software Epi perspective: –Provide access to district staff –District data review Completeness and accuracy Syndrome categorization –Guidelines for use of system and follow-up

18. Sample Detector Output Listing

19. Sample Query Function

21. Bar Chart

22. Insert Cluster or Raw Data Maps

23. Encounter Listings

24. Health Alert Network (HAN)

25. What is Han? Nationwide integrated Information and Communication System for: –Distribution of health alerts –Disseminate prevention & treatment guidelines –Disseminate bioterrorism information & related activities –National disease surveillance –Electronic laboratory reporting –Distance learning –More features planned as development continues

26. What is HAN (more) Web and e-mail based Allows Web Access to Distance Learning Systems Early Warning System to Alert Local, State, and Federal Authorities of Disease Outbreaks and Disasters

27. What Types of Information has been Transmitted Via HAN?

28. Hantavirus

29. SARS

30. West Nile Virus

31. Anthrax

32. Avian flu?

33. In humans?

34. Bioterrorism and Biological Agents

35. Monkey pox

36. Others Measles Rabies Foodborne Outbreaks Treatment Regimens Recalls Vaccine Shortages

37. Who Receives HAN Alerts VDH Epidemiologists VDH Planners VDH Health Directors VHHA Virginia Medical Societies Local Health District E-mail Lists –ICP’s –Physicianlist

38. How Can I Receive These Alerts? Lex.gibson@vdh.virginia.gov

39. www.phppo.cdc.gov/han

40. Questions?