Development and validation of an automated emergency department-based syndromic surveillance system to enhance public health surveillance in Yukon: a lower-resourced and remote setting.

BACKGROUND: Automated Emergency Department syndromic surveillance systems (ED-SyS) are useful tools in routine surveillance activities and during mass gathering events to rapidly detect public health threats. To improve the existing surveillance infrastructure in a lower-resourced rural/remote setting and enhance monitoring during an upcoming mass gathering event, an automated low-cost and low-resources ED-SyS was developed and validated in Yukon, Canada. METHODS: Syndromes of interest were identified in consultation with the local public health authorities. For each syndrome, case definitions were developed using published resources and expert elicitation. Natural language processing algorithms were then written using Stata LP 15.1 (Texas, USA) to detect syndromic cases from three different fields (e.g., triage notes; chief complaint; discharge diagnosis), comprising of free-text and standardized codes. Validation was conducted using data from 19,082 visits between October 1, 2018 to April 30, 2019. The National Ambulatory Care Reporting System (NACRS) records were used as a reference for the inclusion of International Classification of Disease, 10th edition (ICD-10) diagnosis codes. The automatic identification of cases was then manually validated by two raters and results were used to calculate positive predicted values for each syndrome and identify improvements to the detection algorithms. RESULTS: A daily secure file transfer of Yukon's Meditech ED-Tracker system data and an aberration detection plan was set up. A total of six syndromes were originally identified for the syndromic surveillance system (e.g., Gastrointestinal, Influenza-like-Illness, Mumps, Neurological Infections, Rash, Respiratory), with an additional syndrome added to assist in detecting potential cases of COVID-19. The positive predictive value for the automated detection of each syndrome ranged from 48.8-89.5% to 62.5-94.1% after implementing improvements identified during validation. As expected, no records were flagged for COVID-19 from our validation dataset. CONCLUSIONS: The development and validation of automated ED-SyS in lower-resourced settings can be achieved without sophisticated platforms, intensive resources, time or costs. Validation is an important step for measuring the accuracy of syndromic surveillance, and ensuring it performs adequately in a local context. The use of three different fields and integration of both free-text and structured fields improved case detection.

Field investigation with real-time virus genetic characterisation support of a cluster of Ebola virus disease cases in Dubréka, Guinea, April to June 2015.

On 11 May 2015, the Dubréka prefecture, Guinea, reported nine laboratory-confirmed cases of Ebola virus disease (EVD). None could be epidemiologically linked to cases previously reported in the prefecture. We describe the epidemiological and molecular investigations of this event. We used the Dubréka EVD registers and the Ebola treatment centre's (ETC) records to characterise chains of transmission. Real-time field Ebola virus sequencing was employed to support epidemiological results. An epidemiological cluster of 32 cases was found, of which 27 were laboratory confirmed, 24 were isolated and 20 died. Real-time viral sequencing on 12 cases demonstrated SL3 lineage viruses with sequences differing by one to three nt inside a single phylogenetic cluster. For isolated cases, the average time between symptom onset and ETC referral was 2.8 days (interquartile range (IQR): 1-4). The average time between sample collection and molecular results' availability was 3 days (IQR: 2-5). In an area with scarce resources, the genetic characterisation supported the outbreak investigations in real time, linking cases where epidemiological investigation was limited and reassuring that the responsible strain was already circulating in Guinea. We recommend coupling thorough epidemiological and genomic investigations to control EVD clusters.

Exploring challenges and opportunities in detecting emerging drug trends: A socio-technical analysis of the Canadian context.

OBJECTIVES: This study aimed to apply a systems thinking approach to explore factors influencing the detection of emerging drug trends in Canada's provinces and territories to better understand how the local context can influence the design and performance of a pan-Canadian (i.e., national) substance use early warning system (EWS). This study also presents a set of actionable recommendations arising from the results. METHODOLOGY AND METHODS: Semi-structured interviews were conducted with 13 purposively recruited Medical Officers of Health and epidemiologists from across Canada working in the field of substance use. Thematic and social network analysis guided by the socio-technical systems framework were subsequently employed. RESULTS: Barriers and facilitators for detecting emerging drug trends in provinces and territories are a product of the collective linkages and interactions between social (objectives, people, culture), technical (tools, practices, infrastructure), and external environmental (financial, regulatory frameworks, stakeholders) factors. Shortcomings in several of these areas shaped the system's behaviour and together contributed to fragmented operations that lacked strategic focus, poorly designed cross-sector partnerships, and unactionable information outputs. Participants' experiences shaped perceptions of a national substance use EWS, with some voicing potential opportunities and others expressing doubts about its effectiveness. CONCLUSION: This study highlights interconnected social, technical, and external environmental considerations for the design and implementation of a national substance use EWS in Canada. It also demonstrates the value of using the socio-technical systems framework to understand a complex public health surveillance issue and how it can be used to inform a path forward.

RéSUMé: OBJECTIFS: Cette étude visait à appliquer une approche de pensée systémique pour explorer les facteurs influençant la détection des tendances émergentes en matière de drogues dans les provinces et territoires (P/T) du Canada afin de mieux comprendre comment le contexte local peut influencer la conception et le rendement d'un système pancanadien (c.-à-d. national) d'alerte précoce (SAP) en matière de consommation de substances. Cette étude présente également un ensemble de recommandations réalisables découlant des résultats. MéTHODOLOGIE ET MéTHODES: Des entrevues semi-structurées ont été menées auprès de 13 médecins hygiénistes et épidémiologistes recrutés dans tout le Canada et travaillant dans le domaine de la toxicomanie. L'analyse des réseaux thématiques et sociaux guidée par le cadre des systèmes socio-techniques (STS) a ensuite été utilisée. RéSULTATS: Les obstacles et les facilitateurs à la détection des tendances émergentes en matière de drogues dans les provinces et les territoires sont le produit des liens et des interactions collectifs entre les facteurs sociaux (objectifs, personnes, culture), techniques (outils, pratiques, infrastructure) et environnementaux externes (cadres financiers, réglementaires, intervenants). Les lacunes dans plusieurs de ces domaines ont façonné le comportement du système et, ensemble, ont contribué à des opérations fragmentées qui manquaient d'orientation stratégique, à des partenariats intersectoriels mal conçus et à de l'information inexploitable. Les expériences des participants ont façonné les perceptions d'un SAP national sur la consommation de substances, certains exprimant des opportunités potentielles et d'autres exprimant des doutes quant à son efficacité. CONCLUSION: Cette étude met en évidence les considérations sociales, techniques et environnementales externes interconnectées pour la conception et la mise en œuvre d'un SAP national sur la consommation de substances au Canada. Il démontre également la valeur de l'utilisation du cadre STS pour comprendre un problème complexe de surveillance de la santé publique et comment il peut être utilisé pour éclairer une voie à suivre.