*If you have questions about the NSSP CoP, its highly collaborative user groups, the NSSP CoP Slack Workspace (a collaboration platform), or syndromic surveillance, please email syndromic@cste.org.

Community Highlights

2021 Syndromic Surveillance Symposium

To support the growing community of epidemiologists and public health professionals practicing syndromic surveillance, the Council of State and Territorial Epidemiologists (CSTE), in collaboration with the CDC NSSP, will hold the 2nd Annual Syndromic Surveillance Symposium the afternoons of November 16–18, 2021. This year’s symposium will be virtual.

The symposium provides a forum for the syndromic surveillance community to exchange experiences, best practices, and ideas in a broad range of areas (e.g., data sharing, syndrome development, data quality, and analytic methods). Attendees can learn about the latest methods and topics related to syndromic surveillance practice, discuss ideas for building syndromic surveillance capacity, and share thoughts about future NSSP Community of Practice (CoP) activities. Featured topics include health equity, data integration, and the CDC Data Modernization Initiative.

You have through November 15, 2021, to register. We look forward to your participation!

NSSP Community of Practice Monthly Call

CSTE Update

• Federal Use of NSSP Data Project—CSTE has convened a workgroup of state, tribal, local, or territorial (STLT) public health decision makers and surveillance/informatics experts to solicit input on current federal NSSP BioSense Platform data access permission. (Reviewers will also have an opportunity to comment on future revisions to federal NSSP data access.) Workgroup members are collaborating with a third-party consultant to develop a report on considerations and implementation strategies for revising data access, which will be shared with the syndromic community for comment.

NSSP Updates—Karl Soetebier (CDC/NSSP)

• Promoting Interoperability—NSSP is currently working with a group of CoP members to develop communication products on the upcoming rule change for the Centers for Medicare & Medicaid Services Promoting Interoperability Program and its implication for STLT health departments, healthcare partners, and vendors. CDC’s communication staff are also crafting messaging for electronic case reporting (eCR) and syndromic activities. CDC will share materials with the community as they are finalized.
• ESSENCE User Interface—Developers and human systems engineers at the Johns Hopkins University Applied Physics Laboratory are collaborating to assess ESSENCE user interface design and system use practices. They will document current workflows and make recommendations for future updates. They may ask community members who use ESSENCE to participate.

• Health Alert Network (HAN) 451:
  • Recent increases in delta-8 THC-involved adverse events
  • First HAN to use national NSSP data
  • Query details were posted on the #drug-overdose Slack channel.
• Publications—Two MMWRs were recently published:
  • Trends in COVID-19 Cases, Emergency Department Visits, and Hospital Admissions Among Children and Adolescents Aged 0-17 Years
  • Evaluation of Syndromic Surveillance Data for Studying Harmful Algal Bloom-Associated Illness

Trending Topic: Engaging New Partners and Suicide Awareness Month

Krystal Collier (AZ) kicked off this month’s trending topic, “Engaging New Partners and Suicide Awareness Month,” by highlighting how syndromic surveillance continues to demonstrate its value and utility. She emphasized that the long-term potential for syndromic surveillance relies on fostering new collaborations and partnerships. She encouraged community members to reach out to new groups. These groups most likely have valuable data and might be receptive to sharing it with external partners. New engagements will help community members learn from one another and further promote the utility and strengths of syndromic surveillance. The following presentations provided examples of such engagements:

• CSTE/CDC Mortality Pilot Project
  The National Association for Public Health Statistics and Information Systems (NAPHSIS), in collaboration with CSTE and CDC, is piloting a project to improve collection and reporting of mortality data to ESSENCE via the State and Territorial Exchange of Vital Events (STEVE) system.
• Caprice Edwards (NAPHSIS) described the project’s progress. Twelve sites are participating (6 jurisdictions in production and 8 in the onboarding process). The NAPHSIS team expects to complete application programming interface (API) development later this fall. This winter, NAPHSIS will provide a post-project webinar highlighting the project’s best practices, lessons learned, and recommendations.
• If you have questions or want to learn more, please email systems@naphsis.org.

• Syndromic Surveillance Data to Action—Yushiuan Chen, Kyla Munoz, Emma Goforth, and Meredith Henry (Tri-County, CO)
• The Tri-County team was invited to present on their efforts for engaging multi-sector partnerships to prevent suicide and violence in Colorado. Their presentation focused on using syndromic surveillance to acquire actionable data that can make the public health response more robust.
• The team described their process for applying and integrating timely syndromic surveillance data into their mental health framework to inform community prevention efforts. They explained their use of data dashboards to demonstrate suicide and violence-related hospital visits and how this timely information helps them develop and communicate public health messages (e.g., county quarterly reports and alert notifications). The Tri-County team also demonstrated their mental health framework and discussed the strategies and guiding principles that support prevention efforts. The Mental Health and Suicide Prevention Frameworks can be found here.

• Using Syndromic Surveillance to Monitor Adverse Childhood Experiences (ACEs)
  Elizabeth Swedo (CDC/NCIPC) described CDC’s current use of syndromic surveillance to monitor ACEs through various syndrome definitions. People who have experienced ACEs have an increased risk for suicide. Having the ability to monitor and access this population of interest is imperative.
• Syndromic surveillance can monitor direct childhood experiences in ESSENCE by limiting the age to younger than 18 years. Multiple syndromes in ESSENCE can be used to monitor direct and indirect childhood experiences. For direct experiences, the Suspected Child Abuse and Neglect syndrome has been published. The following are in progress: Confirmed Child Abuse and Neglect, Child Sexual Abuse (0–17 years), Child Sexual Abuse (0–10 years), and Dating Violence. Future efforts will focus on developing the following syndromes: Foster Care Involvement, Possible Child Abuse and Neglect, Abusive Head Trauma, and Bullying/Peer Physical Violence.
• ACEs in adults age 18 years and older can be assessed only indirectly because they relate to household challenges. There are two published syndromes for monitoring household challenges: Intimate Partner Violence and Serious Mental Illness. Future efforts will focus on developing a Substance Abuse syndrome definition.
• If NSSP CoP members want to provide feedback or collaborate on an upcoming project, please email Elizabeth Swedo (eswedo@cdc.gov).

NSSP CoP Core Committee

• Krystal Collier (AZ)—Core Committee Chair
• Yushiuan Chen (Tri-County, CO)—Core Committee Deputy Chair
• Jade Hodge (KS)—Data Quality Subcommittee Co-Chair
• Diksha Ramnani (WI)—Data Quality Subcommittee Co-Chair
• Teresa Hamby (NJ)—Knowledge Repository Curation Subcommittee Chair
• Bill Smith (Maricopa Co., AZ)—Syndromic Surveillance and Public Health Emergency Preparedness, Response, and Recovery Co-Chair
• Fatema Mamou (MI)—Syndromic Surveillance and Public Health Emergency Preparedness, Response, and Recovery Co-Chair
• Rasneet Kumar (Tarrant Co., TX)—Syndrome Definition Subcommittee Co-Chair
• Rosa Ergas (MA)— Syndrome Definition Subcommittee Co-Chair
• Natasha Close (WA)—Technical Subcommittee Co-Chair
• Caleb Wiedeman (TN)—Technical Subcommittee Co-Chair

Data Quality (DQ) Subcommittee

• The Data Quality Subcommittee welcomes a new co-chair: Jade Hodge (KS). The subcommittee seeks one more chair to work alongside Jade. Please email syndromic@cste.org for details.
• The September 2021 DQ Subcommittee call featured a discussion of an urgent care clinic definition and the progress being made on the DQ one-pager. The remainder of the call focused on a CSTE and CDC collaboration to gather, characterize, prioritize, and summarize additional data sources and evaluate their value to the NSSP BioSense Platform. Amy Laurent and Leslie Fierro, the project consultants, discussed their progress and invited participants to join an ad hoc call to continue the discussion about data sources.
• Link to previous call recordings and other resources from the DQ Subcommittee here.

Knowledge Repository (KR) Curation Subcommittee

Shown above is the County Health Department Epidemiology Hurricane Toolkit, provided by the Florida Department of Health. This flexible toolkit can be used in response to hurricanes, wildfires, flooding, tornadoes, and other natural disasters.

• Check out the newly added content
  • Florida County Health Department Epidemiology Hurricane Toolkit
  • September 2021 Data Quality Subcommittee Call
  • September 2021 NSSP CoP Monthly Call
  • September 2021 NSSP ESSENCE User Group
  • September 2021 Race and Ethnicity Data Quality Improvement Workgroup Call
  • September 2021 SPHERR Subcommittee Call
  • September 2021 Syndrome Definition Subcommittee Cal
• Do you have syndromes, resources, or anything else related to syndromic surveillance to add to the KR? If so, please email syndromic@cste.org.
• Email syndromic@cste.org if you have issues with the KR.

Syndrome Definition (SD) Subcommittee

• During the September SD Subcommittee call, participants discussed which syndrome definition the subcommittee should develop next, and attendees voted on potential ideas. When the group reconvenes in October, they will finalize the decision. If there is a topic you are interested in, please email subcommittee co-chairs Rosa Ergas (MA) and Rasneet Kumar (Tarrant County, TX).
• Check out previous call recordings and other resources from the SD Subcommittee here.

Syndromic Surveillance and Public Health Emergency Preparedness, Response, and Recovery (SPHERR) Subcommittee

• During the September 2021 SPHERR call, Lakshmi Radhakrishnan (CDC/NSSP) presented a draft version of the Ivermectin Ivermectin is a prescription medication approved by the U.S. Food and Drug Administration (FDA) to treat certain infections caused by internal and external parasites.^*
• Check out previous call recordings and other resources from the SPHERR Subcommittee here.

Technical Subcommittee

• Check out previous call recordings and other resources from the Technical Subcommittee here.external icon

*At the time of publication, the use of ivermectin to prevent or treat COVID-19 is not approved by the FDA. CDC issued a health advisory on August 26, 2021, about the increase in ivermectin prescriptions and reports of severe illness when products containing ivermectin were used to prevent or treat COVID-19. For more information, see the National Institutes of Health (NIH) COVID Treatment Guidelines for ivermectin. NIH’s website also contains the latest COVID-19 treatment guidelines.

A new CMS rule will benefit public health jurisdictions that participate in NSSP or use a local syndromic surveillance system by requiring facilities to submit syndromic data.

The Centers for Medicare & Medicaid Services (CMS) is promoting sustainability and readiness so that public health agencies are better prepared to respond to emerging health threats. On August 2, 2021, CMS published the final rule for changes to the Medicare Promoting Interoperability Program. The rule revised the requirements for eligible hospitals and critical access hospitals (CAHs) participating in the Medicare Promoting Interoperability Program. These hospitals are now required to have four of the measures associated with the Public Health and Clinical Data Exchange Objective: Syndromic Surveillance Reporting, Immunization Registry Reporting, Electronic Case Reporting, and Electronic Reportable Laboratory Result Reporting. Currently, these measures are optional. Under this change, an eligible hospital or CAH will receive 10 points for the Public Health and Clinical Data Exchange objective if they report a ‘‘yes’’ response for all four measures. The rule will take effect beginning with the reporting period in calendar year 2022.

The final rule requires hospitals with emergency departments (EDs) to attest that they are actively engaged with a public health agency to submit data for measures related to nationwide surveillance for early warning of emerging outbreaks and threats. Hospital submission of syndromic data supports public health agencies as they prepare to respond to both future health threats and long-term COVID-19 recovery.

Public health jurisdictions can declare readiness if they are able to receive messages in a locally administered syndromic surveillance system or if they direct submitters to send messages directly to the NSSP BioSense Platform, which makes data available to the jurisdictions’ authorized users. The NSSP onboarding team will help sites coordinate with the facilities to set up data feeds and begin transmission.

QUICK TIP: Does your website explain the new CMS ruling and how it can benefit public health? Now is a good time to make sure your website links to CMS “Promoting Interoperability Programs.”external icon

Links:
CDC Data Modernization Implementation Support: Improving Surveillance Systems New
CDC Resources: Public Health Data Interoperability
FY2022 IPPS/LTCH PPS Final Rule fact sheet
FY2022 IPPS/LTCH PPS Final Rule on the Federal Register

This article includes excerpts from a CMS.gov press release dated August 2, 2021.