1. QSurveillance: Supporting Public Health Emergencies Julia Hippisley-Cox On behalf of QSurveillance team EMIS NUG, Warwick, 2009

2. Outline for QSurveillance Presentation Overview of - Its role in various emergencies in last 5 years - Critical data reporting for Swine Flu Pandemic - CMO’s most recent national briefing - Proposal for Vaccine Safety Study

3. September 2009 Acknowledgements EMIS practices David Stables Andy Whitwam Sean Riddell Fiona Baker Debbie Walton INS (for help with disaster recovery July 09) John Croasdale HPA Gillian Smith Alex Elliott Sally Harcourt Sue Smith Liam Donaldson (slides)

4. Largest real time surveillance system worldwide (23m+patients) Only system to be able to report to PCT Used to monitor seasonal outbreaks of disease e.g. influenza, norovirus Real time response to public health incidents Compliments NHS Direct, RCGP, National Pandemic Service Influenza virus particles Flooding, Oxfordshire, 2007 © HPA, Jane Bradley QSurveillance real-time surveillance

5. QSurveillance Core part of the Emergency Response. Reports to HPA and HPU Department of Health CMO’s Office Cobra WHO Academic Modellers Used to make national and local policy decisions Also used for reassurance

6. Examples: Ricin and London Bombings

7. Examples: Heatwaves

8. Examples: Buncefield

9. Examples: Avon Floods 2007

10. September 2009 Examples: Pandemic 2009

11. In the beginning…

12. Media ‘frenzy’?

13. September 2009 Examples: Pandemic 2009, the ‘first wave’

14. September 2009 Examples: Pandemic 2009, daily consultation rates

15. Age-specific ILI

16. QS regional data

17. April 27 2009 - daily reporting Daily NHS Direct calls Cold/flu; fever; cough Daily QS consult ILI; URTI/LRTI; pneumonia Weekly QS GP consult ILl; URTI/LRTI; pneumonia

18. Examples: Pandemic 2009, England and Wales

19. Examples: Pandemic 2009, daily QSurveillance maps West Midlands

20. Pandemic 2009 QSurveillance maps London

21. Usefulness of data? Following the change to ‘national mitigation’, focus turned to syndromic surveillance At local level, syndromic data used to determine ‘hot spots’ and change policy Syndromic data used to model case estimates Daily data feed to HPA sitrep, DH, CMO

22. Swine Flu Vaccine Safety Study Real time evaluation of vaccine safety Examine at about 30 serious adverse events - Anaphylaxis - Steven Johnson syndrome - Guillain Barre syndrome Need very large sample to get results quickly enough Planning to recruit EMISWeb practices Volunteers for pilot welcome in due course

23. Qsurveillance portal We had to set up emergency web portal for the HPA and CMO, modellers in July 09 Extending this so practices can use it See their own data Draw comparisons between areas – PCTs, SHAs etc http://qsurveillance.qresearch.org