Innovative Uses for Syndromic Surveillance

EID Journal Home > Volume 16, Number 4–April 2010

Volume 16, Number 4–April 2010
Dispatch
Innovative Uses for Syndromic Surveillance
Erin K. O'Connell, Guoyan Zhang, Fermin Leguen, Anthoni Llau, and Edhelene Rico
Author affiliation: Miami–Dade County Health Department, Miami, Florida, USA

Suggested citation for this article

Abstract
To determine if expanded queries can be used to identify specific reportable diseases/conditions not detected by using automated syndrome categories, we developed new categories to use with the Electronic Surveillance System for the Early Notification of Community Based Epidemics. Results suggest innovative queries can enhance clinicians' compliance with reportable disease requirements.

Surveillance and control of communicable diseases are critical for the health status of a community. Traditional passive surveillance refers to health authorities' receipt of reports of diseases or conditions submitted by physicians, laboratories, and other healthcare providers as required by public health legislation. However, reportable diseases are often underreported to health departments (1,2). Syndromic surveillance has been defined as "an investigational approach where health department staff, assisted by automated data acquisition and generation of statistical alerts, monitor disease indicators in real-time or near real-time to detect outbreaks of disease earlier than would otherwise be possible with traditional surveillance" (3). Since 2005, the Miami–Dade County Health Department has used the Electronic Surveillance System for the Early Notification of Community Based Epidemics (ESSENCE) as part of its comprehensive syndromic surveillance system. The system categorizes chief complaints into 11 syndromes: botulism-like, exposure, fever, gastrointestinal illness, hemorrhagic illness, influenza-like illness, injury, neurologic, rash, respiratory, and shock-coma. Of the county's 23 acute-care hospitals, the 17 largest, which account for 90% of the county's emergency department visits, participate in ESSENCE. Staff epidemiologists rotate duties and dedicate 2 hours a day, including weekend, to syndromic surveillance activities. Monday through Friday daily reports are sent to community partners.

Syndromic surveillance was primarily designed to detect disease outbreaks and unusual public health events earlier than could be detected by traditional public health surveillance methods. However, if an outbreak or cluster of illness is too small, the method used currently for syndromic surveillance cannot trigger a statistical alert. We wanted to ascertain the value of syndromic surveillance in improving regular communicable disease surveillance and reporting. The possibility of using ESSENCE to detect specific diseases emerged when varicella (chickenpox) became a newly reportable disease in Florida in 2006; few cases were being reported despite the fact that guidelines had been mailed to all healthcare practitioners. We used a query in ESSENCE to search for "chicken pox or varicella" in the chief complaint field and contacted the hospital Infection Control Practitioners to verify if identified events could be confirmed as reportable conditions. After we did preassessment of the underreporting of chickenpox in 2007 (4), three additional query categories for daily investigation were created in ESSENCE.

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Suggested Citation for this Article
O'Connell EK, Zhang G, Leguen F, Llau A, Rico E. Innovative uses for syndromic surveillance. Emerg Infect Dis [serial on the Internet]. 2010 April [date cited]. http://www.cdc.gov/EID/content/16/4/669.htm

DOI: 10.3201/eid1604.090688