Community of Practice Updates

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Policy for Federal Access to NSSP Data

In the November NSSP Update, we outlined the findings and implementation strategies of the Federal Access Report presented at the October 2022 NSSP CoP Call. The study evaluated strategies to revise current federal access to NSSP data.

The findings of the report provide a roadmap for updating data use policies to advance public health data modernization. CDC’s Data Modernization Initiative is a move toward connected, resilient, adaptable, and sustainable systems that provide faster, more complete data.1

In the coming months, we will share the proposed data use policy changes with the NSSP community. We look forward to hearing your insights and feedback, and, as always, we thank you for your continued commitment to improving syndromic surveillance practice.

Defining Disability for Syndromic Surveillance Scientific Panel

CDC and the Association of State and Territorial Health Officials (ASTHO) have convened scientific panels to develop diagnostic code-based definitions for disability.

  • Scientific Panel 1, held September 26, 2022, focused on educating participants on the ASTHO and CDC project; convening experts in syndromic surveillance, disability, and preparedness; and discussing how to build syndrome definitions to identify people living with disabilities before, during, and after public health emergencies. Discussion centered around building consensus on guidance that will be used to define disability for the project, outlining future steps of the project, and identifying ways in which the scientific panelists can continue their participation.
  • Scientific Panel 2, held November 14, 2022, collected feedback on the first draft of the definition. The group discussed the disability domains selected by the panel and diagnostic codes associated with each domain. This session combined presentations, breakouts, and discussion. Breakout topics included: comparing functional, medical, and Americans with Disabilities Act definitions of disability; mental health inclusion; and re-considering domains of self-care, learning, and employment.
  • Scientific Panels 3 and 4 will be convened in 2023. Updates on panels 3 and 4 will be provided in NSSP Update when available.

For more information, contact Annie Evans at


To Improve Emergency Response, the Syndromic Surveillance Community Sets Clinical Definition for Disability

man with arm around shoulder of elderly man on walker

A disability1 is any condition of the body or mind (impairment) that makes it more difficult to do certain activities (activity limitations) and interact with the world (participation restrictions). Like everyone, people with disabilities need health care and health programs to stay well, active, and be part of their community.2 Pandemics and other public health emergencies challenge these basic needs.

NSSP CoP Monthly Meeting

The National Syndromic Surveillance Program (NSSP) Community of Practice (CoP) held its monthly meeting on November 16, 2022. On average, 100 to 120 people participate in these meetings. Recordings for the monthly CoP calls are posted in the Knowledge Repository. You can access directly.

NSSP Updates

Acting NSSP Lead Karl Soetebier (CDC NSSP) updated the community on program activities:

  • We’re all aware of the surge in pediatric emergency department (ED) visits and shortages in pediatric beds across the country, with much of this attributed to respiratory illnesses. We want to share a few uses of NSSP data to gain a better understanding on the national level: First, NSSP is contributing to a briefing of the National Security Council, the President’s principal forum for considering national security and foreign policy matters with senior advisors and cabinet officials, which is monitoring the surge in visits to children’s hospitals. National-level data provided by NSSP have been a key source of information each week. Second, members of the Administration for Strategic Preparedness and Response (ASPR) are meeting with clinicians representing children’s hospitals in each U.S. Department of Health and Human Services (HHS) region, and HHS regional data provided by NSSP are being used to inform those discussions.
  • CDC colleagues working on Ebola response preparation have asked how NSSP data can best be used at different levels of a response. We posted this question on Slack to understand whether community members used ED data during the previous Ebola response and, if so, how these data were used. We want to learn more and welcome your comments and suggestions.

Featured Presentations

(November 2022 NSSP CoP Monthly Call)

  • CDC Heat and Health Tracker: Emily Prezzato and Claudia Brown (CDC)
    Background: In 2020, the CDC Climate and Health Program and the Environmental Public Health Tracking Program collaborated to design and launch the CDC Heat and Health Tracker with the goal of helping communities access actual information to address extreme heat. The Tracker is a free, open-access tool that provides real-time local-level heat and health information, pulling data from the CDC tracking network. The Tracker visualizes data using U.S. county-level indicators. Information that would take a fair amount of time and expertise to query and process is available through the Tracker in seconds and is easy to understand.
    Prezzato and Brown, accompanied by other team members of CDC’s Climate and Health Program who helped update and validate the Heat and Health Tracker, gave a live demo of the latest updates. One of their objectives was to discuss ways in which syndromic data were being used in localities and identify opportunities for collaborating in the future. Unfortunately, we were not able to include the demo in the meeting recording.
  • Using Syndromic Surveillance During the Holidays: Michael Sheppard (CDC) and Howard Burkom (Johns Hopkins University Applied Physics Laboratory [JHU-APL])
    For background, Sheppard and Burkom have collaborated for several years, focusing on anomaly detection algorithms and how these algorithms can be extended, or improved, and how ESSENCE temporal anomaly detection algorithms can be implemented into the Rnssp package. For those unfamiliar with the Rnssp package, it is a collection of tools, functions, and analytic RMarkdown templates. The NSSP team developed and maintains Rnssp to support the community of practice.
    Burkom launched the discussion by explaining the standard ESSENCE regression-based temporal anomaly detection algorithm. Because this presentation focused on holiday surveillance, Burkom detailed how the ESSENCE algorithm works for holidays and post holidays and how the day-of-week/trend term would not be biased by long-term trends.
    Sheppard followed by sharing screen shots of the Rnssp data repository webpage, showing the location of source code for the anomaly detection algorithms, and then focused on implementation of the regression algorithm introduced by Burkom. Implementation supports tidy-based workflows and supports both grouped and ungrouped data frames, which is helpful for users who want to run detection algorithms on data sources not housed within ESSENCE or want to adjust the algorithm parameters.
    This detailed presentation was recorded in full and shows the underlying source code for the Rnssp implementation of the regression detection algorithm and demonstrates the Rnssp function in action with HHS region-stratified time series for respiratory syncytial virus (RSV)-related emergency department visits. This presentation also includes a brief demonstration of how R users can compute a day-of-week variable for a given input vector of dates.


1. Rnssp GitHub repository:
2. Rnssp vignette on anomaly detection algorithms and trend classification:
3. Burkom HS, Elbert Y, Magruder SF, Najmi AH, Peter W, Thompson MW. Developments in the Roles, Features, and Evaluation of Alerting Algorithms for Disease Outbreak MonitoringJohns Hopkins APL Technical Digest. 2008;27(4):313–331.

  • Syndromic Surveillance as an Alternative Data Source Supporting Early Reimbursement for Synagis to Combat RSV: Gabriel Ann Haas (KS)
    Haas presented a use case for syndromic surveillance as an alternative data source for information to support earlier initiation of reimbursement for Synagis. This prescription medication is used in some infants and children to help prevent lung infections caused by RSV. Reimbursement is contingent on evidence of elevated RSV levels in the community.
    Around mid-September 2022, Haas and her colleagues at Kansas Department of Health and Environment (KDHE) felt some frustration because they did not have sufficient laboratory testing data to trigger the Medicaid reimbursement criteria for Synagis administration, while other states in the region were already meeting the criteria. Haas and the state epidemiologist met with the Medicaid program, which agreed that syndromic surveillance could be an additional data source and—given its broader and more representative coverage in the state—would provide a better mechanism for understanding RSV activity than relying solely on reporting of RSV from a very limited set of providers, as was the case previously. As part of this change, they would need to post the syndromic surveillance data publicly. Consequently, KDHE quickly designed and posted a dashboard with information that could be added to the Medicaid form as an alternative data source to support reimbursement (see Kansas Syndromic Surveillance Program Respiratory Related Visits).
    Haas shared her screen to demonstrate how the dashboard worked. She emphasized the importance of this opportunity to work with the Medicaid program and, through collaboration, contribute to public health actions that produced tangible results.
  • Respiratory R Markdown Reports: Michael Sheppard (CDC)
    Sheppard gave an overview of the new R Markdown flex dashboard report that NSSP created to show trends for several respiratory-related chief complaint (CC) and discharge diagnosis (DD) categories at national and HHS regional levels. This dashboard consists of interactive maps, daily and weekly time series, summaries of temporal alerts, and trend analyses for four syndrome definitions: the broad acute respiratory diagnosis definition, COVID-19 definition, influenza diagnoses, and RSV. NSSP auto generates this report internally each week; the version shared broadly via the application is a snapshot. This report can be accessed under the “Ad-Hoc Analyses” section in the “Reports” tab within the NSSP COVID-19 Exploratory Analysis Shiny application. The app can be accessed through the AMC by selecting “AMC Dashboards and Visualizations.” Weekly and daily reports to support COVID-19 surveillance are also auto generated.
    Using a timely example, Sheppard showed how the dashboard can support ongoing surveillance for respiratory conditions. He oriented attendees to the data included in reports—the four respiratory-related syndrome definitions and CC/DD categories. Sheppard walked attendees through more advanced anomaly detection algorithms that NSSP has recently started applying to multi-year weekly time series that exhibit seasonality, ultimately showing how out of sync RSV is this season as compared with previous seasons.
    This detailed and technical step-by-step description of how to show RSV trends cannot be adequately summarized here and should be viewed by visiting the NSSP CoP Knowledge Repository.
    All work is done to support the NSSP CoP. If you have questions or want help with using the R Markdown reports, please contact Michael Sheppard at
Blockquotes CoP December 2022

Michael Sheppard, November 16, 2022, presentation to
the NSSP CoP

Reminders and Announcements

  • By the time this newsletter is published, the 2022 Syndromic Surveillance Symposium (December 6–8, 2022) will have concluded. NSSP health scientists led more than 15 trainings and discussions. Look for the symposium resources to be posted in the NSSP CoP Knowledge Repository in early 2023.
  • New Slack channels added: #hospital-admission, #r-user, and #sas-user
  • CSTE Annual Conference 2023: Meet, build relationships, and network with colleagues and experts in areas including informatics, infectious diseases, substance use, chronic disease, and injury control. Join more than 2,500 public health epidemiologists from across the nation in workshops, plenary sessions, oral breakout sessions, roundtable discussions, and poster presentations. The plan is to hold conference sessions in person; however, CSTE will monitor circumstances and public health recommendations for group gatherings.
    • June 25–29, 2023 in Salt Lake City, Utah
    • Deadline for submission of abstracts is January 5, 2023.
    • To register and learn more, visit the conference site.
  • Leadership Opportunities:
    • Technical Workgroup Co-chair Position: If interested, email Caleb Wiedeman (
  • Holiday Rescheduling of Meetings:
    • Cancelled: December 28, 2022, NSSP CoP Monthly Call
Join the NSSP CoP Slack Workspace
Slack Channels

It’s easy to join. And the community is always exchanging ideas, exploring possibilities, and discussing topics relevant to today’s surveillance challenges.

So what are your colleagues discussing?

  • #covid19
  • #data-quality
  • #data-sharing
  • #drug-overdose-use
  • #environmental-health-and-severe-weather
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  • #general
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  • #planned-analyses-and-publications
  • #race-and-ethnicity
  • #random
  • #r-user
  • #sas-user
  • #spherr
  • #syndrome-definitions
  • #technical
  • #training
  • #violence-surveillance

Find and Join Channels

  1. Hover cursor over “Channels” on left side of Slack space.
  2. Click the three dots icon that appears next to “Channels” titled “Section Options.”
  3. Select “Browse Channels.”
  4. Find and join any channel that looks interesting!