Active biosurveillance in an urban metropolitan area Sheryl L. Happel Lewis, MPH 1 Kathy Hurt-Mullen, MPH 2 Wayne Loschen, MS 1 Richard A. Wojcik, MS 1 Joseph S. Lombardo, MS 1 November 18, 2003 1 The Johns Hopkins University Applied Physics Laboratory 2 Montgomery County Department of Health and Human Services
ESSENCE II Test Bed Montgomery County Military & Civilian Over-the-Counter Sales Doctors Visits Absenteeism ESSENCE II Archive Hospital Emergency Room ESSENCE II PROCESSING & NOTIFICATION Multiple Secure Web Sites Public Health Emergency & Response Program Public Health Surveillance & Epidemiology NCA ONLY Animal Health ESSENCE I ARCHIVE Fire & Rescue Diagnostic Labs Tri-Service Healthcare Pharmacy Worldwide U.S. Military (DOD GEIS) System Objectives: Outbreak screening Disease identification & tracking Outbreak management
Vision for ESSENCE II Fully Identified Records Pharmacy Data De-Identified Records De-Identified Data Sharing Animal Health Diagnostic Labs District of Columbia Surveillance System Physician ESSENCE I NCR Military Data Tri-Service Outpatient Visits Over the Counter Sales ESSENCE II NCR Integrated Surveillance Physician Physician Virginia Surveillance System Maryland Surveillance System Absenteeism Diagnostic Labs Environmental Samples EPA Diagnostic Labs
Data Capture and Transmission Local Surveillance System Users Electronic Medical Records Capture ER Log Hospital Archive Encrypted Transfer Secure FTP Site Hosp. Dir. Encrypted Transfer Outbreak Detection Algorithms System Archive Data Sharing Policies Encrypted E-Mail ESSENCE development team County Health Dept. Automated Surveillance Query ER Chief Complaint Sufficiently De-Identified Data Elements Automated Coding Process Sufficiently Anonymous Data Elements Participating
Relevant Value to Public Health ESSENCE data used to provide outbreak estimates needed for exercise response planning Additional Surveillance Requests (Montgomery County Department of Health and Human Services) Developed county-wide simulation exercise with county hospitals Provided surveillance information during county rabies investigation Increased surveillance after reports of Influenza A in the Netherlands Increased malaria surveillance based on malaria cases in 2002
Montgomery County Simulation Characteristics for the Simulation Clandestine release of a biological agent Agent must be highly communicable At least 100 patients must present at each hospital Interaction with public health officials during the simulation Deliverables from JHU/APL Create release scenario Develop inject numbers and symptoms for each hospital Develop interactive web sites for hospitals and public health officials
8.00 8.33 8.67 9.00 7.33 7.67 7.00 1000 900 800 700 600 500 400 300 200 100 0 Plague Epicurves Total Cases = 26421; Incubation Period 2-4 days 3.33 3.67 4.00 4.33 4.67 5.00 5.33 5.67 6.00 6.33 6.67 3.00 2.67 1 sigma 2 sigma 50.0% Plague Epicurve Day after Exposure 2.00 2.33 1.67 1.33 1.00 Number of New Cases
ESSENCE Experience 1. System Usefulness: - Health department requests for threshold adjustment during high profile events in the NCR - System used for exercise planning and operations - Ability to continually monitor the health status of the population under surveillance 2. Flexibility: - System accepts a wide variety of data standards for acquisition and data sharing - System easily adaptable to different jurisdictions, data volumes, and data providers - Several versions have been implemented for military preventive medicine and civilian health departments 3. Acceptability: - Acceptance by most data providers has been exceptional - Use by public health has been a function of the risk level - NCR network expected to improve acceptance
ESSENCE Experience (cont.) 4. Portability: - System is being provided to several state and local health departments modifications are needed for local GIS shape files, zip codes, and data providers. 5. Stability: - System has been acquiring data since 1999 and has run since this time without interruption. 6. System Costs: - System size and cost are a function of the size of the jurisdiction the number of data providers, and the size of the Epi department assigned to surveillance and follow-up. Minimum configuration for a county would consist of: (1-2 PC computers, $15K off-the-shelf software, one part-time epidemiologist, and one part-time IT staff member)