The collaborative experience of creating the National Capital Region Disease Surveillance Network.

The Johns Hopkins University Applied Physics Laboratory (JHU/APL) implemented state and district surveillance nodes in a central aggregated node in the National Capital Region (NCR). Within this network, de-identified health information is integrated with other indicator data and is made available to local and state health departments for enhanced disease surveillance. Aggregated data made available to the central node enable public health practitioners to observe abnormal behavior of health indicators spanning jurisdictions and view geographical spread of outbreaks across regions.Forming a steering committee, the NCR Enhanced Surveillance Operating Group (ESOG), was key to overcoming several data-sharing issues. The committee was composed of epidemiologists and key public health practitioners from the 3 jurisdictions. The ESOG facilitated early system development and signing of the cross-jurisdictional data-sharing agreement. This agreement was the first of its kind at the time and provided the legal foundation for sharing aggregated health information across state/district boundaries for electronic disease surveillance.Electronic surveillance system for the early notification of community-based epidemics provides NCR users with a comprehensive regional view to ascertain the spread of disease, estimate resource needs, and implement control measures. This article aims to describe the creation of the NCR Disease Surveillance Network as an exceptional example of cooperation and potential that exists for regional surveillance activities.

Pediatric patient asthma-related emergency department visits and admissions in Washington, DC, from 2001-2004, and associations with air quality, socio-economic status and age group.

BACKGROUND: The District of Columbia (DC) Department of Health, under a grant from the US Centers for Disease Control and Prevention, established an Environmental Public Health Tracking Program. As part of this program, the goals of this contextual pilot study are to quantify short-term associations between daily pediatric emergency department (ED) visits and admissions for asthma exacerbations with ozone and particulate concentrations, and broader associations with socio-economic status and age group. METHODS: Data included daily counts of de-identified asthma-related pediatric ED visits for DC residents and daily ozone and particulate concentrations during 2001-2004. Daily temperature, mold, and pollen measurements were also obtained. After a cubic spline was applied to control for long-term seasonal trends in the ED data, a Poisson regression analysis was applied to the time series of daily counts for selected age groups. RESULTS: Associations between pediatric asthma ED visits and outdoor ozone concentrations were significant and strongest for the 5-12 year-old age group, for which a 0.01-ppm increase in ozone concentration indicated a mean 3.2% increase in daily ED visits and a mean 8.3% increase in daily ED admissions. However, the 1-4 yr old age group had the highest rate of asthma-related ED visits. For 1-17 yr olds, the rates of both asthma-related ED visits and admissions increased logarithmically with the percentage of children living below the poverty threshold, slowing when this percentage exceeded 30%. CONCLUSION: Significant associations were found between ozone concentrations and asthma-related ED visits, especially for 5-12 year olds. The result that the most significant ozone associations were not seen in the age group (1-4 yrs) with the highest rate of asthma-related ED visits may be related to the clinical difficulty in accurately diagnosing asthma among this age group. We observed real increases in relative risk of asthma ED visits for children living in higher poverty zip codes versus other zip codes, as well as similar logarithmic relationships for visits and admissions, which implies ED over-utilization may not be a factor. These results could suggest designs for future epidemiological studies that include more information on individual exposures and other risk factors.

Utility of the ESSENCE Surveillance System in Monitoring the H1N1 Outbreak.

The Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE) enables health care practitioners to detect and monitor health indicators of public health importance. ESSENCE is used by public health departments in the National Capital Region (NCR); a cross-jurisdictional data sharing agreement has allowed cooperative health information sharing in the region since 2004. Emergency department visits for influenza-like illness (ILI) in the NCR from 2008 are compared to those of 2009. Important differences in the rates, timing, and demographic composition of ILI visits were found. By monitoring a regional surveillance system, public health practitioners had an increased ability to understand the magnitude and character of different ILI outbreaks. This increased ability provided crucial community-level information on which to base response and control measures for the novel 2009 H1N1 influenza outbreak. This report underscores the utility of automated surveillance systems in monitoring community-based outbreaks. There are several limitations in this study that are inherent with syndrome-based surveillance, including utilizing chief complaints versus confirmed laboratory data, discerning real disease versus those healthcare-seeking behaviors driven by panic, and reliance on visit counts versus visit rates.

Enhancing Disease Surveillance Event Communication Among Jurisdictions.

Automated disease surveillance systems are becoming widely used by the public health community. However, communication among non-collocated and widely dispersed users still needs improvement. A web-based software tool for enhancing user communications was completely integrated into an existing automated disease surveillance system and was tested during two simulated exercises and operational use involving multiple jurisdictions. Evaluation of this tool was conducted by user meetings, anonymous surveys, and web logs. Public health officials found this tool to be useful, and the tool has been modified further to incorporate features suggested by user responses. Features of the automated disease surveillance system, such as alerts and time series plots, can be specifically referenced by user comments. The user may also indicate the alert response being considered by adding a color indicator to their comment. The web-based event communication tool described in this article provides a common ground for collaboration and communication among public health officials at different locations.