biosense 2.0 webinar: panel on ili surveillance ili surveillance in connecticut
DESCRIPTION
BioSense 2.0 Webinar: Panel on ILI Surveillance ILI Surveillance in Connecticut. Alan J. Siniscalchi, MPH, MS. Influenza & Bioterrorism Surveillance Coordinator State of Connecticut Department of Public Health & the International Society for Disease Surveillance - PowerPoint PPT PresentationTRANSCRIPT
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Alan J. Siniscalchi, MPH, MS Influenza & Bioterrorism Surveillance CoordinatorState of Connecticut Department of Public Health& the International Society for Disease Surveillance(ISDS) Public Health Practice CommitteeWednesday, December 4, 2013
BioSense 2.0 Webinar: Panel on ILI Surveillance ILI Surveillance in Connecticut
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Presentation Objectives To outline the types of surveillance systems designed for detecting influenza, bioterrorism agents, and emerging infections in ConnecticutTo describehow these systems have been used to track ILI and flu-associated morbidity and mortality throughout the stateTo discuss which surveillance systems provide the best value for use in the identification and tracking of influenza outbreaks To emphasize the value of providing real-time data in assessing risk, reducing exposure, and preventing disease
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Surveillance Objectives: Why should health departments conduct ongoing surveillance for seasonal influenza & emerging diseases? Situational Awareness (to detect and track emerging agents and disease activity)Health Professional Awareness and Asset Management (to provide necessary information for optimal use of vaccine supplies, etc.)Public Education & Risk Communication (to provide sufficient information to members of the public to enable them to make informed choices)
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Surveillance Systems in Connecticut by Category (arranged by group and speed of detection): How soon do you want to know? Group 7. Mortality Surveillance: 122 Cities, Pediatric mortality Group 6. Traditional Laboratory Surveillance: Flu subtypes Group 5. Reportable Disease Surveillance: State & federalGroup 4. Special Hospitalization & Laboratory Surveillance: Flu-associated hospitalizations, GPR testing for anthraxGroup 3. Other Surveillance: Institutional outbreaksValue: These provide important, but slow (many days after exposure) information on the etiological agent & characterization of the disease and risk factors.
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Surveillance Systems in Connecticut, cont. Group 2. Syndromic Surveillance (early symptoms, hours days after exposure): These systems measure ILI before diagnosis and laboratory confirmation, including ILINet outpatient providers; the CT Hospital Admissions Syndromic Surveillance (HASS) System, established in all 32 CT acute care hospital campuses following September 11, 2001; the CT Hospital Emergency Department Syndromic Surveillance (HEDSS) System, in operation since 2004; BioSense & othersValue: For situational awareness & rapid identification and tracking of severe outbreaks & epidemics.
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Surveillance Systems in Connecticut, cont.Group 1. Remote Collection & Sensing Surveillance (dispersal, before widespread exposure): A variety of state and federal systems are available for real-time detection of bioterrorist agents. Remote thermal imagining systems can be used in airports and other transportation centers to detect travelers with influenza and other febrile illness. Value: Development and implementation of an expanded network of thermal imaging and other automated remote sensing systems would provide early detection and management of imported cases.
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Chart3
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1213493100378
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752503200241
220193000102
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302400012
10120004
0180005
201200017
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32700012
30180005
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1113900015
228300043
561273000256
2302549000627
2602698110858
2243529010740
1465297000440
410141001213
19178000115
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Type Unknown
Type B Seasonal
Type A (Unspecified)
Type A (H3N2) Seasonal
Type A (H1N1) Seasonal
Type A (Unsubtypeable)
Type A (H1N1) Novel 2009
MMWR Week (April 2009 - May 2010)
No. Tests Reported
Figure 1. Laboratory Confirmed Tests by Influenza Type and Subtype During the 2009 Influenza A (H1N1) Pandemic in Connecticut
Sheet2
Fig. 1 Lab Confirmed Tests By Type/Subtype: Weeks 15 (2009) thru Week 23 (2010) (05/21/2010 Update)
MMWR WeekReported TestsCalc.ActualMMWR Week
2009-10 DatesType A (H1N1) Novel 2009Type A (Unsubtypeable)Type A (H1N1) SeasonalType A (H3N2) SeasonalType A (Unspecified)Type B SeasonalType UnknownTotalTotals
04/12/2009-04/18/20091500103509915
04/19/2009-04/25/20091601013106616
04/26/2009-05/02/20091719014353416111911917
05/03/2009-05/09/2009182605172324777718
05/10/2009-05/16/200919440229260210310319
05/17/2009-05/23/2009201690114621224924920
05/24/2009-05/30/200921220006980633033021
05/31/2009-06/06/2009229800141305356556522
06/07/2009-06/13/200923378001493312199699623
06/14/2009-06/20/200924293000573111097797724
06/21/2009-06/27/20092524100250327582382325
06/28/2009-07/04/20092610200019302231731726
07/05/2009-07/11/20092751000961515315327
07/12/2009-07/18/200928440003914888828
07/19/2009-07/25/200929140003812555529
07/26/2009-08/01/200930120002403393930
08/02/2009-08/08/20093140001201171731
08/09/2009-08/15/2009325000810141432
08/16/2009-08/22/200933170001202313133
08/23/2009-08/29/2009349000201121234
08/30/2009-09/05/2009358000700151535
09/04/2009-09/12/20093650001403222236
09/13/2209-09/19/20093712000723242437
09/20/2009-09/26/20093850001803262638
09/27/2009-10/03/20093970001921292939
10/04/2009-10/10/2009401500039111666640
10/11/2009-10/17/20094143000832213013041
10/18/2009-10/24/20094225600027315658658642
10/25/2009-10/31/20094362700054922301408140843
11/01/2009-11/07/20094485801169822601820182044
11/08/2009-11/14/20094574001052932241497149745
11/15/2009-11/21/200946440000297514688888846
11/22/2009-11/28/20094721310014104139639647
11/29/2009-12/05/2009481150007811921321348
12/06/2009-12/12/2009493000037113818149
12/13/2009-12/19/200950230001704444450
12/20/2009/12/26/200951150001111282851
12/27/2009-01/02/20105217000700242452
01/03/2010-01/09/201011300070323231
01/10/2010-01/16/20102800020212122
01/17/2010-01/23/20103700070115153
01/24/2010-01/30/20104500041111114
01/31/2010-02/06/201058000102121215
02/07/2010-02/13/201061300040017176
02/14/2010-02/20/201071100001012127
02/21/2010-02/27/201086000201998
02/28/2010-03/06/201094000300779
03/07/2010-03/13/20101030000003310
03/14/2010-03/20/20101100011002211
03/21/2010-03/27/20101210001002212
03/28/2010-04/03/20101300002002213
04/04/2010-04/10/20101401001002214
04/11/2010-04/17/20101510000001115
04/18/2010-04/24/20101600001001116
04/25/2010-05/01/20101700000000017
05/02/2010-05/08/20101850000005518
05/09/2010-05/15/20101910000001119
05/16/2010-05/22/20102000000000020
05/23/2010-05/29/2010210000000021
05/30/2010-06/05/2010220000000022
06/06/2010-06/12/2010230000000023
YTD Totals:3541222288327102974867486YTD Totals:
Last report:00000000Last report:
Change:354122228832710297486Change:
Sheet3
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Figure 2. CT ILINet Physician Provider % Influenza-like Illness (ILI) Visits vs. Hospital Emergency Department Syndromic Surveillance (HEDSS) System % Fever/Flu ED Visits (April 2009-April 2010)
MMWR Weeks (April 2009 April 2010)
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Graph_Rates
3.78545006173.77605873874.1582830315
3.96000526254.29464906182.8764805415
3.84310618073.83382484933.355271648
3.96970807384.20537897314.0201654602
4.17374423684.14916634853.6916677499
3.995433794.30052476643.8905459733
4.35987903234.61313480464.0887226082
4.36979035114.37697659714.0033477472
4.26821235674.51440053583.7974683544
5.14388489214.64012654893.9300097209
5.15253423014.94648916734.1074474133
4.72704714644.14883962143.5153019024
5.0473186124.82305936073.7999441185
4.71665314644.135856623648
4.40126419294.666079738449
4.10204540355.032467532550
5.09911141495.743286650451
6.25600219517.784342688352
5.60576453359.4194072271
5.41769041777.10273374112
4.96417604916.54016445293
4.54035175256.14976805834
4.59572376516.121642975
5.181154944.81962481966
4.75328748945.10735611747
4.66718668754.62962962968
4.68888607274.89109169179
4.56719273084.231779836810
4.68629961594.839128178511
4.53240104884.628901127712
4.3803143524.446262956913
4.0010193685.082932049214
4.58250988144.888496913215
4.69739174475.210420841716
4.17876530744.42004504517
4.37763713084.267366385918
3.83405902274.375951293819
3.82173856724.259559098320
4.12729985084.590248962721
3.77111431194.049844236822
3.59749071823.95610350923
3.93208221633.60396039624
4.00793650794.430551780425
4.24283765353.921052631626
4.23752057053.28602480527
3.38528359733.549540347328
3.19162517553.421717171729
3.60906217072.980392156930
3.26440369363.027834351731
3.92857142863.309660994232
3.49367748663.255069370333
3.44513780553.368983957234
2011-12
2012-13
2013-14
MMWR week
Percent of total admissions
Figure 3: Connecticut Hospital Admissions Syndromic Surveillance (HASS) System, Percent of total statewide admissions for pneumonia; 2011-12, 2012-13, 2013-14
Data
2007-082008-092009-102010-112011-122012-132013-14
MMWR WEEKtotal admissionsPneumoniatotal admissionsPneumoniatotal admissionsPneumoniatotal admissionsPneumonia
####%#%#%#%
3522326426679092793.5381103073.7976272883.7874553104.16
3628925330471932653.6876013013.9671953094.2970922042.88
3727227835678462513.2075722913.8477992993.8377492603.36
3827524734584783143.7081873253.9781803444.2177363114.02
3930129232284223023.5982423444.1778573264.1576932843.69
4028729932780382953.6778843154.0078133364.3077113003.89
4128732532482203674.4679363464.3675223474.6174843064.09
4227635934780413284.0879183464.3779053464.3871692874.00
4328528438278303023.8675913244.2774653374.5171892733.80
4431934543481653183.8983404295.1475863524.6472012833.93
4533036445578463033.8683264295.1576623794.9570362894.11
4632135044880163474.3380603814.7377133204.1572542553.52
4730931837171503234.5269743525.0570083384.8271582723.80
4831934239983933524.1986294074.7279793304.14
4935939637580923264.0385433764.4079513714.67
5033135236685033514.1388983654.1080084035.03
5130634232269753304.7373153735.1077834475.74
5239338742875374846.4272894566.2667705277.78
137940844387585065.7881884595.6173896969.42
246537843179714645.8281404415.4280115697.10
341837940582014305.2478163884.9679055176.54
437137539082323584.3580173644.5475454646.15
537240342176403905.1081383744.6075964656.12
641745343087764294.8980874195.1869303344.82
746545643390394134.5782893944.7578714025.11
846742339683544265.1076923594.6772363354.63
949840342782724235.1178913704.6976673754.89
1049139136182443914.7483643824.5772313064.23
1143039634881554195.1478103664.6977083734.84
1240034238479414365.4980093634.5376263534.63
1341934635182483954.7977623404.3873323264.45
1440235137482723894.7078483144.0074763805.08
1535936931181744084.9980963714.5879373884.89
1630437132973203825.2278983714.7074853905.21
1731432633382553944.7779213314.1871043144.42
1830534132581023704.5775843324.3872413094.27
1928328830381533694.5382683173.8378843454.38
2029832231278523294.1977192953.8280293424.26
2130832033682323544.3080443324.1377123544.59
2235436129380033984.9776372883.7773832994.05
2332632927379973604.5078112813.6073812923.96
2431034627381233424.2178333083.9375752733.60
2527336527779213304.1775603034.0173583264.43
2629631223876482863.7473303114.2476002983.92
2729731525476683294.2972923094.2478212573.29
2825828925881303033.7378282653.3978322783.55
2927526828681702863.5078332503.1979202713.42
3025127125978672523.2075922743.6176502282.98
3126325123780072453.0676892513.2673652233.03
3224327221978982563.2478403083.9374632473.31
3322224126077552483.2076712683.4974962443.26
3424326224377153224.1776922653.4574802523.37
..
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Figure 4. Temporal and Regional Trends during the Novel H1N1 Influenza Pandemic, Connecticut Hospital Emergency Department Syndromic Surveillance (HEDSS) System: Percent of ED visits for fever/flu syndrome category, April 12, 2009 April 24, 2010
Chart1
0.05542123860.04258339250.05351875260.04077761970.044315484
0.04916512060.03551136360.05337450370.04444444440.0465235174
0.10006615940.06799784130.09594496740.08142857140.0756123536
0.08277814790.05546955620.07552392250.07402361490.0641699018
0.07037614840.04397961920.04995871180.06648817490.0612435718
0.09883170190.0571955720.06849860610.06739032110.0723562152
0.11171056810.05826636050.0715378730.05913043480.0816411107
0.13919247120.06270967740.0939024390.07660359940.0877714286
0.15553536270.0927723840.0933601610.08890807080.0999555753
0.14680030840.11524522830.11315789470.09149209060.0872206025
0.12190049590.1129607610.1028618830.09122653860.0759162304
0.08027369830.07290886390.08373015870.07857142860.0660402685
0.06429691580.05344918380.07896924360.07009142360.0516802444
0.05380839850.0385789620.05623164080.05347593580.0471371505
0.04674945220.03840722960.05709107390.05712979890.0453212477
0.04947634530.04615809840.06177156180.04314259760.0414522584
0.05247597930.03821857230.04921339250.05392156860.0346496815
0.0559312740.04249370980.04622871050.04149184150.0419618529
0.04943032430.03670953910.02366863910.04616763780.0432291667
0.05373785450.03768020970.06258148630.05086245020.0356143475
0.05398410060.05225726650.05095026280.05239982390.0446941976
0.06189967980.04729546070.05154236630.05682289510.0438551759
0.06132243160.05622617530.06303939960.06720890410.0459117875
0.05574973790.05176533050.06980961020.06353944560.0463931349
0.05682931610.04671968190.05875347360.05942432680.0442825112
0.04906666670.0509612450.06739811910.06112132350.0454174599
0.06068292680.0509612450.07445887450.06322640630.0451977401
0.07008347890.08442710180.13749060860.09098824550.0625854058
0.09256868890.11179758750.21389459270.16368179930.0938656795
0.12777486450.14691702610.21886296420.20188161510.1387918123
0.15110585850.1702878870.1551661190.18623159570.1500353857
0.14360313320.12911795960.11588330630.11736263740.124252988
0.12448060940.09652628340.10020120720.10279488390.0970817683
0.10150238180.07671149140.07731092440.08304498270.0839520274
0.09175738720.05822368420.06287944490.06908548710.0554517134
0.07091254750.05670426070.07688744790.05809768640.0509080083
0.07520837370.05397251090.06990881460.06748140280.0659139457
0.07205806120.0672074160.06645187270.0540284360.0612984118
0.06928532460.05172923440.07077072220.05380059230.0500287522
0.06354515050.05070866140.06074140240.04850934820.0447849146
0.06522131890.05542658150.06337448560.05357989570.0539691605
0.06551724140.05204236010.06317473010.05805515240.0550979835
0.06879194630.0577213660.05901911890.06012950970.0602731591
0.05932510890.04902296880.0630888980.07068803020.0519633894
0.04886236480.04857055030.0584772370.05104305370.0495659479
0.05670407560.03932082220.05409836070.060.0469455311
0.05481309320.04726516050.04671280280.0545630130.0395480226
0.04962636520.04302627780.05244122970.0605370960.0392766318
0.04100946370.03832853030.05188488040.04510250570.0377875137
0.05437536540.0343750.05528089890.05121170550.0410882843
0.04581901490.03853839570.06027164690.04575786460.0422416221
0.05018753350.03823701110.05089576550.04622764940.0368841178
0.05359200920.03401162790.05111294310.04681046350.0423131171
Spring 2009 H1N1 Wave
Fall 2009 H1N1 Wave
Region 1
Region 5
Region 4
Region 3
Region 2
Region 1
Region 2
Region 3
Region 4
Region 5
MMWR Week
Sheet1
Region1Region2Region3Region4Region5
MMWRTotalFev/Flu%TotalFev/Flu%TotalFev/Flu%TotalFev/Flu%TotalFev/Flu%
1553772985.54%28181204.26%23731275.35%2109864.08%37911684.43%
1653902654.92%28161003.55%22671215.34%2205984.44%39121824.65%
17604660510.01%37062526.80%27622659.59%21001718.14%46953557.56%
1860044978.28%38762155.55%25291917.55%22021637.40%43792816.42%
1957694067.04%37291644.40%24221215.00%22411496.65%42782626.12%
2063346269.88%37942175.72%25111726.85%22111496.74%43123127.24%
21630270411.17%34842035.83%26141877.15%23001365.91%48263948.16%
22658891713.92%38752436.27%24602319.39%21671667.66%43753848.78%
236603102715.55%37083449.28%24852329.34%23172068.89%450245010.00%
24648595214.68%413947711.52%266030111.32%23392149.15%41163598.72%
25625176212.19%336438011.30%241124810.29%22912099.12%38202907.59%
2659924818.03%40052927.29%25202118.37%23801877.86%37252466.60%
2757393696.43%37982035.34%24061907.90%22971617.01%39282035.17%
2855012965.38%36031393.86%23831345.62%22441205.35%37551774.71%
2954762564.67%35411363.84%22071265.71%21881255.71%37511704.53%
3055382744.95%36181674.62%25741596.18%2202954.31%34981454.15%
3154122845.25%31661213.82%24791224.92%22441215.39%39251363.46%
3254713065.59%35771524.25%24661144.62%2145894.15%36701544.20%
3357052824.94%37321373.67%2028482.37%22311034.62%38401664.32%
3450432715.37%30521153.77%23011446.26%22611155.09%39311403.56%
3554092925.40%32341695.23%24731265.10%22711195.24%38261714.47%
3656223486.19%36791744.73%25611325.15%24111375.68%39221724.39%
3756263456.13%31481775.62%26651686.30%23361576.72%38771784.59%
3857223195.57%37671955.18%22061546.98%23451496.35%37291734.64%
3951032905.68%30181414.67%25191485.88%21541285.94%35681584.43%
4056252764.91%32771675.10%25521726.74%21761336.11%36771674.54%
4151253116.07%32771675.10%23101727.45%21511366.32%35401604.52%
4251513617.01%28192388.44%266236613.75%22972099.10%36592296.26%
4354235029.26%339938011.18%292262521.39%240139316.37%37823559.39%
44572173112.78%394157914.69%304366621.89%255151520.19%400655613.88%
45592389515.11%368262717.03%273942515.52%251346818.62%423963615.00%
46612888014.36%376448612.91%246828611.59%227526711.74%401649912.43%
47577671912.45%32533149.65%248524910.02%211121710.28%34613369.71%
48545855410.15%32722517.67%23801847.73%20231688.30%35022948.40%
4951444729.18%30401775.82%23061456.29%20121396.91%32101785.55%
5052603737.09%31921815.67%21591667.69%19451135.81%33591715.09%
5151593887.52%29831615.40%23031616.99%18821276.75%32772166.59%
5257874177.21%34522326.72%24831656.65%21101145.40%35892206.13%
154993816.93%33831755.17%20631467.08%20261095.38%34781745.00%
253823426.35%31751615.07%22391366.07%1979964.85%33941524.48%
355353616.52%34461915.54%24301546.34%21091135.36%35021895.40%
455103616.55%33051725.20%25011586.32%20671205.81%35211945.51%
553643696.88%33091915.77%24061425.90%21621306.01%33682036.03%
655123275.93%29171434.90%24411546.31%21221507.07%33871765.20%
753622624.89%32531584.86%25481495.85%22531155.10%35711774.96%
850792885.67%33571323.93%24401325.41%21501296.00%33231564.69%
951632835.48%33641594.73%23121084.67%20711135.46%33631333.95%
1052192594.96%34631494.30%22121165.24%21971336.05%35391393.93%
1153892214.10%34701333.83%24671285.19%2195994.51%36521383.78%
1251312795.44%35201213.44%22251235.53%21871125.12%36021484.11%
1352382404.58%35031353.85%23561426.03%2098964.58%35511504.22%
1455992815.02%34261313.82%24561255.09%22931064.62%36331343.69%
1552062795.36%34401173.40%24261245.11%21791024.68%35451504.23%
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Conclusions and Recommendations Various syndromic and other advanced surveillance systems all provide valuable data useful for state and local jurisdiction efforts to detect outbreaks, identify emerging disease, and track influenza The value of ED-based and other syndromic surveillance systems in providing real-time data cannot be understatedContinued efforts to automate these systems will also reduce the demand on increasingly limited public agency resources and allow agencies to maintain a wide network of systems resulting in a superior level of public health preparedness
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Acknowledgements The CT DPH Influenza & BT Surveillance Teams (2003 - present): Zygmunt F. Dembek, PhD, MS, MPH*; Maria T. Andrews, MPH*; Roxanne Ryan*; Sara A. Niesobecki, MS* & other interns; Brenda Esponda, BS, BA; Jianxin Sun, MD, PhD; Amanda Morrison, MPH*; Stephanie Petrahai, MPH*; & Nancy Barrett, MS, MPH; Susan Petit, MPH, Heather Altier, BA; Zack Fraser, BS; Field Epidemiologists: Jessica Brockmeyer, MPH; Kasia Frenette, MPH*; Paul Gacek, MPH; Jaime Krasnitski, MPH; Lisa LoBianco Pippa, MPH*; Ava Nepaul, MPH*; Katherine M. Purviance, MPH*; Kristen Soto, MPH; along with Terry Rabatsky-Ehr, MPH; Randall S. Nelson, DVM, MPH; Pat Mshar, MPH*; & Matthew L. Cartter, MD, MPH; Lynn Sosa-Bergeron, MD; James L. Hadler, MD, MPH*; CDC EIS Officers; & lab support by Tim Brennan, Diane Barden, & others; (*former team member) Questions? [email protected]
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