1. Alan J. Siniscalchi, MPH, MS Influenza & Bioterrorism Surveillance Coordinator State of Connecticut Department of Public Health & the International Society for Disease Surveillance (ISDS) Public Health Practice Committee Wednesday, December 4, 2013 BioSense 2.0 Webinar: Panel on ILI Surveillance ILI Surveillance in Connecticut

2. Presentation Objectives 1. To outline the types of surveillance systems designed for detecting influenza, bioterrorism agents, and emerging infections in Connecticut 2. To describe how these systems have been used to track ILI and flu-associated morbidity and mortality throughout the state 3. To discuss which surveillance systems provide the best value for use in the identification and tracking of influenza outbreaks 4. To emphasize the value of providing real-time data in assessing risk, reducing exposure, and preventing disease

3. Surveillance Objectives: Why should health departments conduct ongoing surveillance for seasonal influenza & emerging diseases? 1. Situational Awareness (to detect and track emerging agents and disease activity) 2. Health Professional Awareness and Asset Management (to provide necessary information for optimal use of vaccine supplies, etc.) 3. Public Education & Risk Communication (to provide sufficient information to members of the public to enable them to make informed choices)

4. Surveillance Systems in Connecticut by Category (arranged by group and speed of detection): How soon do you want to know? Group 7. Mortality Surveillance: 122 Cities, Pediatric mortality Group 6. Traditional Laboratory Surveillance: Flu subtypes Group 5. Reportable Disease Surveillance: State & federal Group 4. Special Hospitalization & Laboratory Surveillance: Flu-associated hospitalizations, GPR testing for anthrax Group 3. Other Surveillance: Institutional outbreaks Value: These provide important, but slow (many days after exposure) information on the etiological agent & characterization of the disease and risk factors..

5. Surveillance Systems in Connecticut, cont. Group 2. Syndromic Surveillance (early symptoms, hours – days after exposure): These systems measure ILI before diagnosis and laboratory confirmation, including ILINet outpatient providers; the CT Hospital Admissions Syndromic Surveillance (HASS) System, established in all 32 CT acute care hospital campuses following September 11, 2001; the CT Hospital Emergency Department Syndromic Surveillance (HEDSS) System, in operation since 2004; BioSense & others Value: For situational awareness & rapid identification and tracking of severe outbreaks & epidemics.

6. Surveillance Systems in Connecticut, cont. Group 1. Remote Collection & Sensing Surveillance (dispersal, before widespread exposure): A variety of state and federal systems are available for real-time detection of bioterrorist agents. Remote thermal imagining systems can be used in airports and other transportation centers to detect travelers with influenza and other febrile illness. Value: Development and implementation of an expanded network of thermal imaging and other automated remote sensing systems would provide early detection and management of imported cases.

11. Conclusions and Recommendations 1. Various syndromic and other advanced surveillance systems all provide valuable data useful for state and local jurisdiction efforts to detect outbreaks, identify emerging disease, and track influenza 2. The value of ED-based and other syndromic surveillance systems in providing real-time data cannot be understated 3. Continued efforts to automate these systems will also reduce the demand on increasingly limited public agency resources and allow agencies to maintain a wide network of systems resulting in a superior level of public health preparedness

12. Acknowledgements The CT DPH Influenza & BT Surveillance Teams (2003 - present): Zygmunt F. Dembek, PhD, MS, MPH*; Maria T. Andrews, MPH*; Roxanne Ryan*; Sara A. Niesobecki, MS* & other interns; Brenda Esponda, BS, BA; Jianxin Sun, MD, PhD; Amanda Morrison, MPH*; Stephanie Petrahai, MPH*; & Nancy Barrett, MS, MPH; Susan Petit, MPH, Heather Altier, BA; Zack Fraser, BS; Field Epidemiologists: Jessica Brockmeyer, MPH; Kasia Frenette, MPH*; Paul Gacek, MPH; Jaime Krasnitski, MPH; Lisa LoBianco Pippa, MPH*; Ava Nepaul, MPH*; Katherine M. Purviance, MPH*; Kristen Soto, MPH; along with Terry Rabatsky-Ehr, MPH; Randall S. Nelson, DVM, MPH; Pat Mshar, MPH*; & Matthew L. Cartter, MD, MPH; Lynn Sosa-Bergeron, MD; James L. Hadler, MD, MPH*; CDC EIS Officers; & lab support by Tim Brennan, Diane Barden, & others; (*former team member) Questions? alan.siniscalchi@ct.govalan.siniscalchi@ct.gov