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Detection of an influenza epidemic using an electronic medical record-based bioterrorism surveillance system during the 2002 Winter Olympics.
Hegmann-KT; Hegmann-KB; Wendelboe-AM; Alder-SC; Lyon-JL; White-GL; Magill-M
Am J Epidemiol 2003 Jun; 157(11)(Suppl):S50
Surveillance has traditionally, though inefficiently, relied upon paper records and phone calls from physicians. The 2002 Winter Olympics provided an opportunity to implement a bioterrorism surveillance system using an electronic medical record (EMR). This EMR allowed for daily updates of diagnoses. Statistical process control was used to monitor daily ICD-9 coded diagnoses across a clinic system (approximately 100,000) for syndromic patterns of disease consistent with bioterrorism or natural epidemics. An influenza epidemic was identified in January 2002. A significant proportion of cases (rapid test positive) were unexpectedly affected by nausea (16.6%), vomiting (17.9%) and diarrhea (4.9%) that may have resulted in additional cases with significant gastrointestinal symptoms remaining undiagnosed. Subsequent analyses of the prior influenza season found still higher prevalences of nausea (31.1 %) and vomiting (24.4%) in those testing positive. Additionally, antiviral prescriptions were significantly greater in 2002 than 2001 (52.4% vs. 17.8%, p<0.05), likely augmented in part by real-time feedback !O clinicians. However, rapid testing of high probability cases decreased substantially in 2002 (Odds ratio = 0.35, 95% CI = 0.25, 0.50), suggesting greater reliance on clinical diagnosis. Improved outbreak surveillance in the future using such systems appears promising for both major events and routine communicable diseases.
Epidemiology; Surveillance-programs; Biological-weapons; Biological-warfare-agents; Medical-monitoring; Diagnostic-techniques; Infection-control; Infectious-diseases; Respiratory-infections; Electronic-devices; Diagnostic-tests; Viral-infections; Clinical-diagnosis; Clinical-tests
Issue of Publication
American Journal of Epidemiology
University of Utah, Salt Lake City, Utah