Syndromic Surveillance The Municipal Public Health The Municipal - PDF document

2/16/2011 Syndromic Surveillance The Municipal Public Health The Municipal Public Health Experience For ehealthinformation For ehealthinformation Feb 16, 2011 Cameron McDermaid MHSc Epidemiologist cameron.mcdermaid@ottawa.ca Syndromic Surveillance  What is surveillance? “ongoing systematic collection, analysis and interpretation of outcome-specific data for use in the planning, implementation and evaluation of public health practice” p p Centers for Disease Control and Prevention 2 1

2/16/2011 Syndromic Surveillance  Syndrome: • The sum of symptoms and signs • The sum of symptoms and signs of any morbid state. • Used in clinical medicine for triage, investigation, and initial management • Does not require a “confirmed” q diagnosis 3 Syndromic Surveillance  Syndromic Surveillance: • Infer disease from patterns/syndromes p y in existing data streams. • Many possible data streams • Case classification accomplished by data mining health records 4 2

2/16/2011 Why Do Syndromic Surveillance? Syndromic Surveillance Notifiable Disease Reporting SYNDROME S O umber of Cases DIAGNOSED ILLNESS EXPOSU RE Nu Time 5 Emergency Room CBRN Attack Detection by Medical Records Surveillance (ECADS)  Funding: CRTI  PI: Richard Davies  Scientific Team Scientific Team • University of Ottawa Heart Institute • Michigan State University National Food Safety and Toxicology Center • Carnegie Mellon University Auton Laboratory • Grey Bruce Public Health Unit • All Grey Bruce area Hospitals  Federal Government Partners • National Research Council, Institute for Marine N ti l R h C il I tit t f M i Biosciences (NRC/IMB) • National Research Council, Institute for Information Technology (NRC/IIT) • Public Health Agency of Canada, Laboratory Centre for Disease Control (LCDC) 6 3

2/16/2011 Emergency Room CBRN Attack Detection by Medical Records Surveillance (ECADS)  ECADS Technical Team • AMITA Corporation • Performance Support Services Inc pp • Cam Emergency Preparedness • e-Privacy Systems Inc  ECADS Collaborators • CNPHI Project, PHAC • Office for Public Health Practice, PHAC (Centre for Surveillance Coordination) • Canada Health Infoway • MOHLTC-funded QUESST Project (Ontario Syndromic Surveillance Pilot, KFLA Public Health Unit) • Michigan State Department of Public Health 7 Background Data  Friday May 19, 2000 Call from pediatrician, home for aged. • Call/Faxes to schools, hospital, PUC, Lab •  Saturday May 20 Presumptive e. coli results • Calls/FAX to hospitals, PUC Calls/FAX to hospitals PUC •  Sunday, May 21 E. coli confirmed, presumptive water samples, cultures • obtained Outbreak number assigned, OMT formed, boil water • advisory  Monday, May 22 Patients contact, food interview sheet. • OMT Expanded, treatment protocol, hotline established p , p , •  Tuesday May 23 LPHL advised 2 water samples collected Sunday +ve E. • coli Joint HU and hospital press conference • Physician meeting • All health units notified via Ministry of Health notice • 8 4

2/16/2011 May 15, 2000 The redder the dot, The bigger the dot, the higher the the greater the proportion of ER number of ER visits visits classified as GI. classified as GI 9 May 16, 2000 10 5

2/16/2011 May 17, 2000 11 May 18, 2000 12 6

2/16/2011 May 19, 2000 13 May 20, 2000 14 7

2/16/2011 May 21, 2000 15 May 22, 2000 16 8

2/16/2011 May 23, 2000 17 May 24, 2000 18 9

2/16/2011 May 25, 2000 19 May 26, 2000 20 10

2/16/2011 May 27, 2000 21 May 28, 2000 22 11

2/16/2011 May 29, 2000 23 May 30, 2000 24 12

2/16/2011 May 31, 2000 25 Total ER Visits to 10 Grey Bruce Area Hospitals All ER Visits 500 Count Count 250 00 0 0 200 200 400 400 600 600 800 800 1000 1000 1200 1200 DAY DAY Jan 1, 1999 Dec 31, 2001 26 13

2/16/2011 GI Syndromes vs. Total Visits 3 Year Data Set - 9 Hospitals All ER Visits 500 GI Syndrome Count Count 250 00 0 0 200 200 400 400 600 600 800 800 1000 1000 1200 1200 Jan 1, 1999 Dec 31, 2001 DAY 27 GI Syndromes 3 Year Data Set - 9 Hospitals 150 125 100 Count 75 50 25 0 0 200 400 600 800 1000 1200 DAY Jan 1, 1999 Dec 31, 2001 28 14

2/16/2011 All ER Visits SBG Health Centre (Walkerton) 200 All ER Vi it All ER Visits 150 Count Count 100 50 0 0 0 0 200 200 400 400 600 600 800 800 1000 1000 1200 1200 DAY DAY Jan 1, 1999 Dec 31, 2001 29 All Visits vs. GI Syndrome: SBG Health Centre (Walkerton) 200 All ER Vi it All ER Visits GI Syndrome 150 Count Count 100 50 0 0 0 0 200 200 400 400 600 600 800 800 1000 1000 1200 1200 DAY DAY Jan 1, 1999 Dec 31, 2001 30 15

2/16/2011 GI Syndrome SBG Health Centre (Walkerton) 125 100 75 Count 50 25 0 0 200 400 600 800 1000 1200 DAY Jan 1, 1999 Dec 31, 2001 31 Boil Water Advisory 160 Symptom onset for 140 120 1335/1346 Cases 100 Culture confirmed 80 Culture negative 60 Not tested 40 40 20 0 14 17 20 23 26 29 2 5 8 11 14 17 20 23 26 29 1 4 7 10 13 16 19 22 25 29 Visits to ER by Walkerton Residents classified as GI Visits to Walkerton ER classified as GI 32 DAY 16

2/16/2011 ECADS Retrospective Analysis of Walkerton Outbreak  Syndromic Surveillance highly sensitive to outbreak of this nature to outbreak of this nature  Would definitely have confirmed concerns of physician on Friday, May 19 and provided data for outbreak investigation  Would likely have detected a GI  Would likely have detected a GI outbreak centered in Walkerton on Friday May 19 had physician not called 33 Why Do Syndromic Surveillance? Syndromic Surveillance Notifiable Disease Reporting SYNDROME S O umber of Cases DIAGNOSED ILLNESS EXPOSU RE Nu Time 34 17

2/16/2011 Selection of Surveillance Point e.g. EMR e.g. Google Trends Sentinel ISIC physicians Information Self Care Primary Emergency Seeking Contact Care Rooms e.g. OTC Antiviral e g OTC Antiviral e g e.g. Screening data Telehealth Data feeds 35 Exploiting the Advantage  Confidence that what you’re seeing is relevant to you is relevant to you  Requires a protocol that allows you to act on what you’re seeing 36 18

2/16/2011 ASSET  Advanced Syndromic Surveillance & Emergency Triage (ASSET) Ver 1 g y g ( )  Based on RODS version 3 with a number of patches 37 ASSET Partners and Collaborators CRTI   PHAC Foodborne, Waterborne and Zoonitic Diseases Norm Yanofsky • Paul Sockett  NRC -IIT • Victoria Edge Janice Singer , Norm Vinson • •  PHAC CNPHI Project Joel Martin, Berry De Bruijn • Amin Kabani Ottawa Public Health  • Shamir Muchti Amira Ali • •  US Partners Isra Levy • Michigan State University –  Ottawa Heart Institute Team • Ewen Todd Susan McClinton • Carnegie Mellon University • Jason Morin • Auton Lab –Daniel Neill Debbie Warren • Michigan Dept of Community •  Grey Bruce Public Health Health – Melinda Wilkins and Hazel Lynn Jim Collins • Alanna Leffley Consultants  • Grey Bruce Area Hospitals  Stephen D’Silva •   Ottawa Area Hospitals Ottawa Area Hospitals Gini Bethel Gini Bethel • •  AMITA Corp Monty Montgomery • Sonny Lundahl John Boufford • • Monica Preston Collaborators  • Anu Pinnamanini Kieran Moore – KFLA Health • • Unit Greg Webster – CIHI • Altarum Corp – Rick Keller • 38 19

2/16/2011 Asset in Ottawa  Four hospitals provide data to ASSET  Data are categorized and analyzed Data are categorized and analyzed every six hours  Data are housed at the Ottawa Hospital  Sends an email alert if the number of cases is higher than expected  System is monitored each day by OPH S stem is monitored each da b OPH epidemiologists 39 40 20

2/16/2011 ASSET in OTTAWA ASSET in OTTAWA  Data includes: • Sequential case ID • Admission date • Case sex • Case age • 5 digit postal code • Symptom/chief complaint • Syndrome S d  Not all sources • Final Diagnosis • CTAS 41 Processing in ASSET  Case is categorized using chief complaint  Tried to jump off two story house  Tried to jump off two story house  Fish hook  Fell and laid in yard for a couple of hours  “I have fleas”  Stuck bead in nose  Squirrel bite 42 21

2/16/2011 Processing in ASSET  Cases are classified using a classifier developed by the National Research developed by the National Research Council of Canada.  Expert classifies symptoms using sample data from the Ottawa hospitals.  The classifier can be retrained or learn new classifications classifications.  Allows a very regional approach 43 The Standard Syndromes  Gastrointestinal  Respiratory  Asthma A th  ILI  Constitutional  Hemorrhagic  Botulinic  Botulinic  Neurological  Rash  Other 44 22