*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.

NSSP CoP Monthly Meeting

The National Syndromic Surveillance Program (NSSP) Community of Practice (CoP) held its monthly meeting on May 25, 2022. On average, 100 to 120 people participate in these meetings. Recordings for the monthly CoP calls are posted in the Knowledge Repository.

The May call included CDC NSSP updates; report outs from NSSP CoP subcommittees, user groups, and technical workgroup; and multiple sites’ recent or planned surveillance efforts on heat-related illness, wildfire surveillance, and hurricane surveillance.

Please view the video for discussion about developing new syndromes, the need for up-front preparation in ESSENCE before disaster strikes, unexpected signs that syndromic surveillance picks up before a storm, how to support back-to-back emergencies, and more—all accompanied by tips, visuals, and personal observations.

NSSP Updates

• CDC is responding to the pediatric hepatitis outbreak of unknown etiology. During the weekly CSTE hepatitis/adenovirus call on May 19, NSSP leadership gave a high-level overview of ESSENCE and hosted a brief panel discussion on use of emergency department (ED) data for case finding. The NSSP team is working with CDC’s pediatric hepatitis response team to share national trends using queries based primarily on the UK syndrome definition and 0–4, 5–11, and 0–11 age groups.
• The NSSP team is working on two projects to validate and improve the query for identifying visits associated with pediatric hepatitis of unknown etiology.
  1. NSSP analysts created a shared spreadsheet where sites can post their queries for identifying ED visits associated with pediatric hepatitis of unknown etiology. Becky Lampkins, CSTE’s facilitator for the NSSP CoP, posted this spreadsheet on CSTE’s SharePoint site ( xlsx), and Amanda Smith (CDC) posted the link on the Syndrome Definitions Slack channel: #chief-complaint-processing.
  2. To better understand which ICD-10 codes are being used to identify persons under investigations (PUIs), Amanda is contacting individual jurisdictions about the codes their analysts and epidemiologists are using for case finding. If you have identified PUIs in your public health jurisdiction but have not heard from Amanda about participating in this validation activity, please email NSSP@cdc.gov, and we will send you the spreadsheet.

Site-provided data about the Discharge Diagnosis codes being used for PUIs will be shared with NSSP CoP members to support case-finding. Numbers will not be identifiable with participating sites. Although this effort is essential for query development and improvement, it is voluntary. The NSSP team appreciates everyone who has submitted (or plans to) submit data.

• NSSP analysts continue to work on the mortality data source. The Daily Site Processing Summary now provides information about recently received mortality data that are viewable by the six participating sites. For sites not actively contributing mortality data, this section will be present in the report but will indicate that no mortality data have been received. If your site wants to add mortality data, please email NSSP@cdc.gov for onboarding assistance.
• During the Syndrome Definition Subcommittee’s May call, NSSP team members shared evaluations and recommendations for the first batch of chief complaint processor changes. These changes address problems that have been reported over the years by the community. The NSSP team continues to work through these changes and will provide updates during future calls. Community members may go to the Slack channel, #chief-complaint-processing, to comment on proposed changes.
• After responding to the proposed changes to the Limited Details data set announced last month, NSSP analysts indicated that a few of the age groups, particularly the Distribute Age Groups and Age Range filters, were not present in the Limited Details. NSSP proposes adding these to the existing age filters in the Limited Details to ensure consistency across data sources.
• Lab A provided NSSP with adenovirus stool specimen data through 2016, the first year that these tests could be ordered. Nationally, the test volume stabilized around September 2017. These findings are specimen-level, not patient-level data. Please use caution when discussing these results. Do not name Lab A or use its local (non-LOINC) codes in any written presentations.

NSSP analysts are seeing an increased volume of test results, especially after CDC’s Health Alert Network (HAN) published report No. 465. These results reflect a return to pre-pandemic percent positivity baseline. Stephanie Dietz (CDC) has posted information in the general Slack channel.

Report Outs

Please access the video for details. The work of these groups helps NSSP leaders set program priorities and promotes best practices. You can learn about CoP membership and each group’s purpose, meeting dates and times, and leadership on the NSSP CoP website.

• Data Quality (DQ) Subcommittee: Jade Hodge (KS) recapped the April meeting topic, how Health Information Exchanges (HIE) fit into the data flow. This was followed by members of several public health jurisdictions explaining how they work with HIEs. The next meeting will be about collecting procedure codes. New ways to monitor changes in data quality have been added to the ESSENCE library and are available for download.
• NSSP ESSENCE User Group: Wayne Loschen (Johns Hopkins University Applied Physics Laboratory) and Aaron Kite-Powell (CDC) encouraged syndromic surveillance practitioners to attend these meetings. Each meeting focuses on answering community members’ questions about ESSENCE and include tips from surveillance experts. Questions may be entered into Slack beforehand to allow Wayne and Aaron time to prepare responses.
• R User Group: Michael Sheppard (CDC) announced that meetings will now be held monthly to cover more topics of interest (for example, use of RShiny app to report anomalies, applied epidemiological offerings and future developments) and to allow time for guest speakers. The most recent meeting was held June 14, 2022; all meetings are posted on the NSSP CoP calendar. A much-requested upcoming topic will be use of the Leaflet for R to create interactive map visualizations. This discussion topic will include a demo of county- and state-level pop-ups that display time-series data visualizations (similar visualizations are included in the COVID reports). Group updates are posted on the Slack channel.
• Syndrome Surveillance and Public Health Emergency Preparedness, Response, and Recovery (SPHERR) Subcommittee: Fatema Mamou (MI) reported that the subcommittee members have been discussing pediatric hepatitis and special-event surveillance. A small group is working on cold weather-related illness/injury surveillance and the possibility of creating a dashboard template.
• Syndrome Definitions Subcommittee: Rosa Ergas (MA) announced that over the past several months, the SD subcommittee has served as a clearinghouse for various community projects. The SD subcommittee is assisting NSSP and CSTE by presenting syndromes and other projects being worked on to the user community. Subcommittee members have received feedback on syndrome definitions and continue to work with the NSSP team to update the chief complaint processor. The subcommittee meetings offer opportunities for collaboration and include tips, troubleshooting, and discussion about hot topics posted on the Slack channel.
• Technical Workgroup: Caleb Wiedeman (TN) reported that the recent workgroup meeting discussion addressed concerns with HL7 fields that could potentially override information in different ESSENCE data fields. The R code for assessing this concern can be found on the technical Slack channel. Community members are encouraged to run the code and post their results. The Technical Workgroup is looking for a co-chair. If you’re interested, please contact Caleb at wiedeman@tn.gov. Community members are encouraged to get involved.

Surveillance Presentations

Go to the May NSSP CoP call video to learn how community members prepare to use ESSENCE before disaster strikes, develop syndromes related to disaster response, respond to unexpected signs that syndromic surveillance picks up before a storm, and support back-to-back emergencies. Discussions are accompanied by tips, visuals, and personal experiences and observations.

Presenters and topics:

• Aaron Gettel (Maricopa County, AZ): Heat Surveillance
• Kali Turner (Washington): Heat-related Illness
• Carol Trenga (OR): Wildfire Surveillance
• Dave Atrubin (FL): Hurricane Surveillance

Reminders and Announcements

• The Knowledge Repository (KR) is getting an overhaul. The KR is a popular feature on the NSSP CoP website that contains NSSP CoP call recordings; syndrome library; and resources on data analytics, data sharing, and more. CSTE developers are enhancing the KR search features and user interface with plans to complete the effort later this summer.
• No NSSP CoP Monthly call will be held in June 2022. The next call will be on July 27, 2022, 12:00–1:30 PM ET.
• The Technical Workgroup is looking for a co-chair. If interested, please contact Caleb Wiedeman at wiedeman@tn.gov.
• 2021 Syndromic Surveillance Symposium recordings and materials have been posted.

Syndromic Surveillance Training Series Coming Summer 2022!

Learning Objectives

1. Describe the general process to categorize records into syndromes
2. Apply characteristics of SyS data (sources, variables, quality) when describing SyS results
3. Distinguish between which public health issues are and are not well suited for SyS

Expected Outcomes

1. Reliably and confidently define a syndrome using typical syndromic surveillance data elements
2. Reliably and confidently describe representativeness and limitations of SyS results
3. Accurately frame and/or develop hypotheses for SyS applications

Learning Objectives

1. Select and apply the analysis method as appropriate for the context and health condition of interest
2. Identify how to utilize SyS data and methods for multiple public health domains

Expected Outcomes

1. Accurately describe appropriate analytic methods to characterize processed SyS data
2. Expand SyS application to additional health conditions of interest and public health domains

Learning Objectives

1. Select appropriate public health actions based on SyS analysis
2. Describe key messages for various target audiences, including data providers, decision makers, and the public

Expected Outcomes

1. Determine appropriate response/public health action based on SyS finding
2. Craft and/or make recommendations for tailored communication per audience profile