Community of Practice Updates

Updated May 23, 2023

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Policy for Federal Access to NSSP Data

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During the November 2022 CoP Monthly meeting, Acting NSSP Lead Karl Soetebier informed the community of efforts to make NSSP data more accessible and to improve collaboration toward common goals.

In early December 2022, Soetebier updated site administrators of NSSP’s ongoing work related to data use. He explained how expanded access to NSSP data during the COVID-19 public health emergency enabled innovation in areas such as trend indicators and classification, anomaly detection, and text mining by age and geography. The ability to work this way routinely, outside the context of a public health emergency, is not permitted by the current data use agreement.

In early 2023, to build on public health response innovations and to continue to enhance data use, CDC began designing a new NSSP agreement to incorporate lessons learned from the COVID-19 response, enable close collaboration between sites and CDC, enable new innovations and services for sites, and maximize responsible use of data and provide timelier synthesis of findings and recommendations. Further, this agreement would help respond to the top concerns raised by public health departments in the Review of Federal Access to National Syndromic Surveillance Program Data: Findings and Implementation Strategies, posted by the Council of State and Territorial Epidemiologists (CSTE) in February 2023.

CDC has made a thoughtful choice to change from a data use agreement (DUA) to a memorandum of understanding (MOU) to better reflect the collaborative nature of the agreement. By refocusing the DUA as an MOU, the collaborative and participatory goals of the partnership across federal, state, and local public health authorities become more transparent. Details of the DUA/MOU are being worked through.

NSSP CoP Monthly Meeting

The National Syndromic Surveillance Program (NSSP) Community of Practice (CoP) met on April 26, 2023. On average, 100 to 120 people participate in these monthly meetings. Recordings for CoP monthly calls are posted in the Knowledge Repository.

NSSP Update

Karl Soetebier, acting NSSP lead, gave an overview of the team’s activities during April 2023:

  • Details of the Data Use Agreement/Memorandum of Understanding (DUA/MOU) are taking longer to work through than anticipated. Soetebier assured attendees that progress is being made on the agreement and accompanying concept of operations. NSSP is closer to being able to share details and plans to do so soon.
  • NSSP has updated the Suicide Attempt v2 definition and added a fact sheet and technical brief for this definition to the NSSP CoP Knowledge Repository (KR). The previous definition, although updated in December 2022, incorrectly searched only the CC/DD field. The updated version now also searches both CC History and DD History fields. Any application programming interfaces (APIs) or dashboards using the old definition will be updated automatically. (Note: NSSP emailed site administrators about this development and posted a notice on Slack.)
  • NSSP recently published fact sheets and technical briefs for CDC Motor Vehicle Crash Occupant Injury v1 and CDC Fentanyl Overdose v1 and revised the materials for CDC All Drug v2 and CDC Stimulants v3. You can find these materials in the KR under “Syndromes.”
  • Data from patient visits to emergency departments (EDs) continue to demonstrate value in informing surveillance of respiratory disease. With the expiration of the public health emergency declaration on May 11, the need to continue monitoring COVID-19 and the effectiveness of prevention and control strategies remain a public health priority. ED data from patient visits have played an important role in this effort over the course of the pandemic and are being called on to do so again. To that end—and as other data sources receive less emphasis—CDC will leverage the NSSP data from ED patient visits that have routinely been presented in COVID Data Tracker over the past two years and add new visuals for ED visits. Improvements include a new landing page, presentation of weekly burden, and a change in metrics. Data in COVID Data Tracker will be updated weekly to include changes in hospitalizations and provisional death data.

Subcommittee and User Group Updates

  • Analytic Tools for Routine Health Surveillance Subcommittee: There was a guest presentation in March by Sara Chronister (WA) about working with rates. The April call featured a presentation on the moving epidemics method for estimating intensity thresholds for diagnostic definitions such as respiratory syncytial virus (RSV).
  • Data Quality Subcommittee: During the April call, attendees discussed how to explore exceptions tables in Datamart and how ESSENCE collapses visits. In place of the May call, the subcommittee held a joint call on May 3, 2023, with the Syndrome Definition Subcommittee.
  • NSSP–ESSENCE User Group: Reminder! This group is looking for topics related to ESSENCE that will improve members’ practice.
  • NSSP R User Group: During the March call, attendees shared tips and tricks for custom CSS formatting in R Markdown. During the April call, attendees discussed regular expressions in detail and how to use with syndromic surveillance data. In May, presenters from Posit will give an overview of the NSSP instance of RStudio. They will present new features, recent upgrades, and information about the company’s transition from RStudio to Posit.
  • Syndrome Definition Subcommittee: A joint subcommittee call with the Data Quality Subcommittee was held May 3, 2023. The subcommittees discussed ICD-9 codes—how often they appear in data, if they are used in combination with other coding systems, the overlap with ICD-10 codes, and how to handle them when drafting syndrome definitions. Syndrome definition and validation work is coming down the pipeline. Details will be provided on the Syndrome Definition Subcommittee call.
  • Technical Workgroup: Rosa Ergas recently joined as a co-chair. The workgroup reviewed spatial alerts that users can customize and suggested improvements. Reminder! Please submit tickets if you want to see changes made to the BioSense Platform.

See the NSSP CoP calendar for upcoming meeting dates and times.

Site-level Respiratory Dashboard Demo

Michael Sheppard (CDC) demonstrated a site-level respiratory dashboard created for Louisiana that can be adapted to other sites. Sheppard began by thanking Elizabeth Mytty (LA) for allowing presentation of the Louisiana Respiratory Dashboard.

In 2022, the NSSP developed a national- and HHS region-level RMarkdown dashboard that summarized trends of respiratory-related diagnostic chief complaint/discharge diagnosis (CC/DD) categories. National- and HHS region-level trends are provided for broad acute respiratory diagnoses, COVID-19, influenza, and respiratory syncytial virus (RSV). Data include raw and smooth percentages, raw counts, and ESSENCE anomaly detection applied to the trend lines. There are also syndrome-specific summaries with granular analysis by age group and with new anomaly detection methods. Finally, there is a summary analytics table that condenses national, HHS regional, and age-stratified results into an interactive table with sparklines.

After Louisiana released the dashboard, the NSSP team agreed to make this dashboard generalizable and customizable so that sites could display their own data. Sheppard shared the Louisiana Respiratory Dashboard that includes similar analyses and trends as the national dashboard but is displayed at the state-level and below. He noted that depending on data available at the site level, data may be sparse when analyzed by age group or small geographic areas.

This dashboard cannot easily be made into a template due to different geographic groupings by sites; however, the NSSP team can work with sites to reproduce this dashboard. Contact to learn more.

Syndromic Surveillance Post-COVID-19 Public Health Emergency Discussion

Anna Frick (AK Department of Health) initiated a discussion about syndromic surveillance’s transition from emergency to routine surveillance for COVID-19 at the end of the Public Health Emergency (PHE) (May 11, 2023). Attendees were polled to get their thoughts on:

  • how the end of the COVID-19 PHE would impact their ability to conduct syndromic surveillance on COVID-19,
  • how they currently use syndromic data for COVID-19 surveillance,
  • how they plan to conduct surveillance of COVID-19 surveillance post-PHE,
  • how important syndromic surveillance is to an ongoing COVID-19 surveillance strategy (e.g., use of emergency department data and NSSP’s ability to integrate data sources), and
  • how the end of the PHE will affect syndromic surveillance for COVID-19.

Many attendees reported that any disruption in their ability to use syndromic surveillance for COVID-19 would be minimal. A few attendees reported that the end of the PHE would, in fact, make syndromic surveillance even more important because it is a long-term system implemented before the COVID-19 pandemic and will remain after the PHE ends. Although many attendees reported using syndromic surveillance to monitor COVID-19 trends, some attendees reported using syndromic surveillance to monitor for Long COVID or Post-COVID Conditions, reviewing deaths due to COVID-19, and determining changing symptom presentation of COVID-19.


COVID-19 Surveillance After Expiration of the Public Health Emergency Declaration ― United States, May 11, 2023 | MMWR (

Correlations and Timeliness of COVID-19 Surveillance Data Sources and Indicators ― United States, October 1, 2020–March 22, 2023 | MMWR (

Long COVID or Post-COVID Conditions | CDC

Reminders and Announcements

  • Welcome to new NSSP CoP Core Committee Deputy Chair Gabriel (Gabe) Ann Haas (KS)! Gabe was nominated and selected in the recent ad-hoc Deputy Chair election. She has held the position of Epidemiologist and Program Manager for the Kansas Syndromic Surveillance Program (KSSP) with the Kansas Department of Health and Environment since 2019. Gabe is passionate about operationalizing syndromic surveillance data for public health action and is always thinking about new use cases for syndromic data.
  • New Workgroup! A Public Use Dataset Workgroup is being formed to:
    • Explore the many questions and considerations for public presentation and release of syndromic surveillance data, and
    • Develop a collective response informed by the community members with a deep understanding of these data.
  • Council of State and Territorial Epidemiologists (CSTE)/CDC NSSP Model Syndromic Surveillance (SyS) Training Series: This training series is designed for new SyS analysts and data consumers to establish foundational concepts of SyS methodology, conceptualize new SyS public health applications, and confidently act on SyS analyses. The series was delivered live in fall 2022 and is now available in an on-demand format on CSTE Learn. NSSP CoP members can access and complete the training for free: create a CSTE Learn account, click “sign up” on home page, register and click “submit.” Once registered, the training can be found here.
  • Join the Community and a subcommittee! Our Community is a great way to meet others working in syndromic surveillance and advance the work of syndromic surveillance at all jurisdictional levels. Become part of the Community or update your NSSP CoP membership to join a subcommittee here. Encourage others to join, too!
    • Join and participate in the Slack workspace. This space is full of rich discussion among colleagues. This is a great opportunity to collaborate with your peers outside of CoP meetings.
    • Submit success stories to be featured in NSSP Update and on the NSSP CoP website. You do great work every day that we want to highlight.
    • Submit a topic for future NSSP CoP monthly calls. These calls are meant for the community, and we want to know what is most important to you.
  • 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 of group gatherings.


Introduction to Syndromic Surveillance (SyS) Methodology

NSSP represents a strategy to integrate near-real–time data with other data sources, connecting healthcare with public health. This training series is designed for new SyS analysts and data consumers to establish foundational concepts of SyS methodology, conceptualize new SyS public health applications, and confidently act on SyS analyses. The series was delivered live in fall 2022 and is now available in an on-demand format on CSTE Learn. NSSP CoP members can access and complete the training for free: create a CSTE Learn account, click “sign up” on home page, register and click “submit.” Once registered, the training can be found here.

SyS State of Mind
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Explore the common data sources and methods that define SyS practice. Learn how analyst query data and craft syndromes for many public health problems. Apply new knowledge to interactive exercises and simulated experiences, preparing learners to look at public health surveillance through a SyS lens.

AnalySyS and Communication
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Translate data into recommendations and public health actions. Learn how to tell a story through SyS analysis interpretation. Simulated learning experiences are coupled with integrated support tools to maximize best practices.

Expanding SyStems
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Identify different SyS analysis methods to support different surveillance and response needs. Learn how to apply a near real-time data source to a diverse set of public health problems, broadening SyS utility. Content for all types of learners, with active engagement, didactic presentations, and action-led micro-learning.

Adult Learning Theory
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Develop trainer skills. Elevate content for effective, formative and meaningful delivery.

Theory Applied- Fishbowl exercise
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Apply adult learning concepts. This exercise supports development and application of trainer skills, fostering a complete learning experience for trainees.

Join the NSSP CoP Slack Workspace
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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?

  • #analytic-tools
  • #chief-complaint-processing
  • #covid19
  • #data-quality
  • #data-sharing
  • #drug-overdose-use
  • #environmental-health-and-severe-weather
  • #essence-user
  • #general
  • #hospital-admission
  • #lab-data
  • #mortality-data
  • #national-data-requests-sop
  • #nssp-cop
  • #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!