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Jeffrey Johnson, MPH Senior Epidemiologist Epidemiology & Immunization Services Branch (EISB) Public Health Services INFLUENZA SURVEILLANCE IN SAN DIEGO COUNTY
Jeffrey Johnson, MPHSenior Epidemiologist
Epidemiology & Immunization Services Branch (EISB)Public Health Services
INFLUENZA SURVEILLANCE IN SAN DIEGO COUNTY
WorldU.S.
San Diego County
California
Influenza Detection & Surveillance
Source: UT San Diego
Influenza in the local news – January 2013
San Diego County Influenza Surveillance All year round Influenza lab result reporting Sentinel sites: rapid flu tests and ILI Influenza death reporting and tracking Syndromic surveillance ILI (local system & BioSense)
EMS transports (local system)
911 calls (Firstwatch)
P&I deaths trends Collaborative information sources
Navy, CA & CDC Border Health, Mexico, social media Distribution of reports, alerts, etc.
San Diego County Reports & Updates Weekly Influenza Watch report e-mailed to
interested people Regular alerts and updates through CAHAN
(California Health Alert Network) Information used in county reports and press
releases
Community Awareness
& Circulating
Virus
Progressing Illness
Outpatient & Hospitalization DeathAbsenteeism
• Baseline trends• New incidents• Vaccinations• Flu strains• Healthcare capacity• Situational awareness• Animal influenza
• School•Work • Staffing levels
• ILI • Self-medicating• Self-monitoring• Nurse hotline• 911 calls• EMS transports
• Clinic• Urgent care• ED visits• ICU cases• Clinical Dx• Lab tests• Prescriptions
•Death certificates• Autopsy
INFLUMATICS
Influenza Surveillance Data Sources
Are we speaking the same ILI language?
Difficulty breathing with fever
Cough with fever
Indicator Frequency
Data Source Criteria Notes
Clinical reporting
Weekly Review of ED records
URI or ARI with specific temp
Person based
Emergency Department
Daily Local syndromic system
C.C. Text parsing
Electronic system
Paramedic transports
Daily & Real time
Local EMS system
Paramedic impressions
Electronic system
911 calls Daily & Real time
FirstWatch 911 call complaints
Electronic system
BioSense Weekly BioSense 2.0 C.C. & ICD9 Electronic system
Sentinel testing sites
Weekly Sentinel testing sites + rapid flu test & ILI
Visit complaint
Person based
MU-ILI TBD Meaningful Use ILI
Text & temp
Under development
ILI Surveillance in San Diego County
San Diego CountyED Syndromic Surveillance ILI
Emergency department data Chief complaints Syndrome categories
Respiratory ED Flu like
Text parsing A chief complaint must contain both a “respiratory” and
“fever” component Many different text options possible
San Diego CountyED Syndromic Surveillance ILI cont.
Example text parsing into ILI•“flu symptoms”•“URI with fever”•“coughing with fever”•“487.1”•“runny nose with fever”•“h/a, cold with fever”
Clinician Reporting of ILI
Clinician Reporting of ILI
Syndromic SurveillanceSyndromic Surveillancevs.
BioSense 2.0 ILI Trends, 2012–13FY
Selected ILI for SD (only), all visits, 7/1/2012 to 6/29/13 (weeks 27–26)
Initial Results x Day
BioSense 2.0
Local Syndromic ILI
Basic Comparison of BioSense ILI vs. Local Syndromic Surveillance
What about Meaningful Use Data?
HL7 messages – ADT A01, A03, A04, A05, A08
OBX segment contains the temperature Demographics
MSH|^~\&|EPIC|….... EVN|A03|20131023143659|…….. ….…. PV1|1|EMERGENCY|………OBX|1|…….. OBX|2|……… OBX|3|NM|MUPTAGE|3|8||||||F OBX|4|NM|MUPTTEMP|4|104.2||||||F DG1|1|ICD-9-CM|487.1^Influenza with other respiratory manifestations^ICD-9-CM|…
Emergency department discharge diagnosis of an 8 year old with a temperature of 104.2 and diagnosis of influenza
06/26/2013
San Diego County Syndromic Surveillance Data Flow
San Diego Health
Connect HIE
County contracted messages broker
Public Health
Services Syndromic
Surveillance
Hospitals
Legend
From BioSense
SFTP ASCII FilesHL7 2.3 (Kaiser)SDHC HIE HL7 2.5
CDCSDHC HIE HL7 2.5 (in progress)
To BioSense (county aggregate)
Atlas Developme
nt Corp
06/26/2013
Concluding Thoughts
ILI is a common population health indicator ILI can apply to many different data sources ILI, by definition, is hard to standardize ILI is one of several key influenza
surveillance components ILI can be useful for surge capacity
benchmarks Syndromic MU-ILI data may have greater
specificity and standardization potential
