NSSP Update – March 2020

Questions and Tips

Q: How can I use the data quality filters in NSSP–ESSENCE when running a query?

A: The Data Flow tab provides both an at-a-glance and a detailed view of Processed, Exceptions, and Filtered records.

By default, the DQ Dashboard shows all your site’s data—every feed, every facility. The view you’ll see in the bar chart will look something like this:

By using other tabs, however, you can see different views that apply different metrics—and each serves a different purpose.

For example, you can use the DQ Dashboard’s Data Flow tab to identify ESSENCE backlogs and other processing issues. To do this, select the Data Flow tab and click the Visit Count Comparison graph. This option lets you see a bar chart with the Count of your site’s Processed Messages by arrived_date as well as your site’s Processed and ESSENCE visit counts by c_visit_date. The y-axis shows the message count, and the x-axis shows the arrived_date. You can drill down even more by selecting any one metric (e.g., Processed Visits versus Processed Messages) to get a better sense of comparison.

If you notice a backlog or see only the sent messages from an earlier Visit Date, you should see a jump in the Processed Message count without a corresponding increase in the ESSENCE and Processed Visit trendlines. Here is an example:

Detailed information about these graphs can be found in the BioSense Platform User Manual for the Data Quality Dashboard. Contact your site inspectors for more information by emailing NSSP@cdc.gov.

Q: How can I use the DQ Dashboard to get facility-level information on Exceptions?

A: To get Processed, Exceptions, or Filtered records for the site, you need to make a few changes. The default selection for Feed is All Feeds. To see Filtered or Exceptions by facility, start by clicking Deselect All feeds.

Once done, select the facility of interest. Change the Date Range to match dates of interest. Give the dashboard a few minutes to realign and display facility-level metrics.

Now you will see data flow metrics for the facility of interest. Here is an example:

Spotlight on Syndromic Surveillance Practice

NSSP’s Role in the EVALI Investigation

The National Syndromic Surveillance Program (NSSP) has received widespread recognition for its role in characterizing e-cigarette, or vaping, product-use associated lung injury (EVALI). CDC Principal Deputy Director, Dr. Anne Schuchat, underscored the unique role that syndromic surveillance plays in characterizing EVALI. “First, it is clear that the outbreak represented a new phenomenon and not recognition of a common syndrome that had evaded our attention,” Schuchat said. “Today’s report in the New England Journal of Medicine (NEJM) regarding analysis of data from the CDC’s National Syndromic Surveillance Program makes it clear that a sharp rise in emergency department visits began in June 2019. And occurrences peaked in September 2019, consistent with our active case reporting from public health departments around the country.”¹  For a comprehensive account of how syndromic data were used to characterize EVALI, please read the NEJM special report “Syndromic Surveillance for E-Cigarette, or Vaping, Product Use-Associated Lung Injury.”²

Related Link
NPR Health Transcript. CDC Says THC Additive is the Culprit in Most Vaping Deaths [Internet]. 2019 Dec 21 [cited 2020 Jan 10]

Collaborations

Kansas* Uses Syndromic Data to Improve Case Reporting for EVALI

Photo Courtesy of C-Span. Kansas Department of Health and Environment Secretary, Dr. Lee Norman, testifies to Congress about the need for a public health investigation of e-cigarette, or vaping, product use-associated lung injury.

The outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI) in the United States received widespread media attention when CDC began investigating a cluster of teens and young adults in Wisconsin and Illinois hospitalized with unexplained, sudden onset severe acute respiratory distress. With the increasing popularity of vaping among youth combined with the severity of this illness, there was a push to identify and prevent additional cases quickly.

The Kansas Department of Health and Environment (KDHE), which routinely uses syndromic data to detect potential health problems, took initiative to make sure healthcare providers unfamiliar with EVALI would not mistake it for other conditions. Kansas epidemiologists began using the national severe lung injury query to actively identify suspected cases. They soon realized that vaping-related terms alone did not always identify people with EVALI and that a diagnosis could be masked by, for example, a patient’s drug or alcohol use. They refined the EVALI query to make it more sensitive and excluded age groups not affected (young children and the elderly) to make the query more specific. They regularly examined this line-level data.

Syndromic surveillance data on EVALI helped Kansas health officials understand the emergence of this condition in their state and raise awareness across health facilities. By communicating with hospitals and infection prevention staff to request records for suspected cases, Kansas health officials also improved medical facility reporting of this life-threatening condition. Through funding from the National Syndromic Surveillance Program, syndromic surveillance is improving the nation’s public health. Read the full story. >>

*EVALI-related content was provided by Epidemiologist Gabriel Ann Haas, Vital Bureau of Epidemiology and Public Health Informatics, Kansas Department of Health and Environment.

Related Links
MMWR: Characteristics of Persons Who Report Using Only Nicotine-Containing Products Among Interviewed Patients with E-cigarette, or Vaping, Product Use–Associated Lung Injury — Illinois, August–December 2019

MMWR: Update: Characteristics of a Nationwide Outbreak of E-cigarette, or Vaping, Product Use–Associated Lung Injury — United States, August–January 2020

Wildfires in California: A Critical Use Case for Expanding State Capacity and Sharing Information across Public Health Jurisdictions

In 2018, California experienced its most destructive wildfire season on record—7,571 fires burned nearly 1.7 million acres, damaged or destroyed 23,300 structures, and resulted in 93 confirmed fatalities.¹ More than 25 million acres of California wildlands are classified as very high or extreme fire threats—a risk area covering more than half the state.² The Camp Fire, which began November 8, 2018, remains California’s deadliest wildfire ever.¹

At the onset of the fires, California’s decentralized and independent public health jurisdictions were in various stages of becoming part of CDC’s National Syndromic Surveillance Program (NSSP). NSSP scientists contacted Sacramento, San Mateo, and other affected sites to propose technical assistance, guidance, and resources. They shared tried and tested queries and visualizations that the Washington State Department of Health had developed to monitor wildfire events. Epidemiologists in Sacramento and San Mateo counties quickly adapted the wildfire-related syndrome definitions and surveillance techniques. They set up monitoring and response plans based on wildfire proximity and magnitude and established data-sharing relationships across jurisdictional lines.

The differences between Sacramento and San Mateo Counties’ surveillance approach shows just how flexible syndromic surveillance can be. Sacramento, for example, monitored emergency department (ED) visits for other wildfire-related health concerns, combining syndromic data with air quality data to improve situational awareness for public messaging. San Mateo consulted with scientists at San Diego County Health and Human Services Agency, an early adopter of syndromic surveillance, and used San Diego’s work as a model for integrating syndromic data with its existing surveillance plan to monitor for health effects of wildfire smoke exposure.

California’s use of syndromic data during the 2018 wildfire season helped launch syndromic surveillance capacity-building initiatives among local health agencies. Further, the state’s experience demonstrates the utility, reliability, and timeliness of syndromic data for monitoring and characterizing wildfire-related health impacts.

Read the full story about this impressive collaboration that evolved out of the 2018 response to wildfires in California. Outcomes include a pilot program on climatic exposures and respiratory health outcomes, formation of new cross-jurisdictional relationships, and a desire for regional collaboration and information exchange around emerging areas of syndromic surveillance.

Georgia Uses Syndromic Surveillance to Identify Cryptosporidiosis Outbreak at Water Park

cryptosporidium

Georgia uses syndromic surveillance to detect potential illness from recreational waters, such as pools and water parks. For the past decade, Georgia’s North Central Health District (NCHD) has experienced increases in Cryptosporidium in Houston County. Cryptosporidium (“Crypto”) is a microscopic parasite that causes diarrhea and other symptoms. Crypto is the leading cause of waterborne disease among people in the United States.¹In July 2018, a new water park opened in Houston County without proper permits. Within 1 month, local public health epidemiologists received complaints of Crypto. On August 8, 2018, NCHD was notified of possible illnesses. NCHD requested contact information for the initial complainants and assistance from the Georgia Department of Public Health (DPH), Acute Disease Epidemiology Section (ADES), to review syndromic surveillance data. On the morning of August 9, ADES epidemiologists provided historic syndromic data suggesting two potential cases. By the end of the day, the two potential cases were laboratory confirmed, two potential cases were pending laboratory results, and two suspect cases were epidemiologically linked with the laboratory confirmed cases. Local epidemiologists and environmental health specialists worked with the water park owner and staff to close the park until proper chlorine levels and contact times were met and the Cryptosporidium was inactive.

A total of 119 cases of Cryptosporidium were associated with this outbreak. The rapid reporting of syndromic surveillance cases within the first week of the outbreak prompted health officials to expand the dates of concern and to investigate additional recreational water facilities.

Read the full story to learn why Georgia includes syndromic data as part of its comprehensive surveillance program.

Collaborations Accelerate Syndromic Surveillance Practice

Technical Updates

New NSSP Publications

Two more manuals are scheduled for publication. Look for them in the Technical Resource Center, Technical Publications and Standards.

NSSP Participation and Coverage