Two Unique Syndromic Surveillance Systems: State and Federal Collaboration to Identify Spike in “Visits of Interest”
Disaster Response, Data Analytics
In New Jersey, a dormitory fire at a university resulted in students visiting emergency departments in two adjacent counties. Data from emergency department visits feed into the syndromic surveillance system, which alerts local and national health officials to changes. CDC National Syndromic Surveillance Program (NSSP) staff saw a spike in visits related to “exposure” and “school exposure” in syndromic data coming from HHS Region 2 and reached out to the region to inquire about the spike.
Upon review of their local data, the New Jersey Department of Health (NJDOH) noticed the dormitory fire visits. NJDOH uses syndromic surveillance to identify illnesses and injuries associated with natural or man-made disasters and to detect infectious disease symptoms or emerging outbreaks and issues of public health concern.
Although not an outbreak or a communicable disease, this event provided an opportunity for NJDOH and NSSP staff to collaborate and compare data to confirm incidents of public health concern. Funding from the NSSP supports the use of syndromic surveillance in improving the nation’s public health.
Public Health Problem
In April 2017, a CDC NSSP syndromic surveillance expert identified a spike in the NJDOH’s hospital ED “Visits of Interest” category based on chief complaint and discharge diagnosis while reviewing HHS Region 2 data within the Electronic Surveillance System for the Early Notification of Community-based Epidemics
(ESSENCE). ESSENCE is an application housed on the NSSP BioSense Platform.
CDC notified the NJDOH surveillance team that NSSP ESSENCE identified an uptick in ED “Visits of Interest.” NJDOH’s data analyst assessed the results of the ESSENCE query and confirmed the increase in “Exposure” and “School Exposure” chief complaints in two contiguous counties. Although these visits had prompted an alert in NJDOH’s SyS system for total visits, the alert was not sustained. Without a communicable disease connection, the alert was closed. To identify the origin of the spike detected by ESSENCE, the NJDOH staff searched local news reports for alert date and determined the visits resulted from a dormitory fire at a university in one of the counties where the visits occurred.
This event was neither an outbreak nor a communicable disease, yet it provided an opportunity for NSSP and NJDOH staff to work together, combining data from both NJDOH’s EpiCenter and CDC’s BioSense Platform to determine whether this event required further investigation. For NJDOH staff, this was a real-world event that combined use of the BioSense Platform with ESSENCE technology. Although the BioSense Platform is not NJDOH’s primary SyS system, having access to alternate algorithms associated with ESSENCE allowed NJDOH the opportunity to compare and confirm incidents of public health concern. Also, the BioSense Platform has different classifications and keyword groupings that could enhance NJDOH’s EpiCenter data.
- Independent state and local health department SyS systems used in tandem with CDC’s NSSP BioSense Platform (ESSENCE application) allow comparison of data related to a spike in ED visits and chief complaints. Such comparison enhances opportunities for health departments to either rule out or confirm incidents of public health concern within their community.
- Routine SyS activities can be enhanced through collaboration.
The findings and outcomes described in this syndromic success story are those of the authors and do not necessarily represent the official position of the National Syndromic Surveillance Program or the Centers for Disease Control and Prevention.