Title: Innovative Uses for ESSENCE to Improve Standard Communicable Disease Reporting Practices in MiamiDad
1Innovative Uses for ESSENCE to Improve Standard
Communicable Disease Reporting Practices in
Miami-Dade County
2Objective
- To illustrate how ESSENCE can been utilized in
order to improve standard communicable disease
reporting
3Table of Contents
- Objective
- Background
- Methods
- Results
- Conclusions
- References
- Acknowledgements
4Background
- Miami-Dade County Health Department (MDCHD) has
used Electronic Surveillance System for the Early
Notification of Community Based Epidemics
(ESSENCE) in 16 of the largest hospitals since
2005 - 4 staff rotate duties and spend about 2 hours on
syndromic surveillance activities daily - Although ESSENCEs primary aim is to detect
outbreaks or bioterrorism events, we wanted to
determine its value in improving communicable
disease surveillance and reporting
5Background
- We first considered the idea when varicella
(chicken pox) became a newly reportable disease
in Florida in 2006, but few cases were being
reported although new guidelines were mailed to
all practitioners - In 2007, we began conducting a specialized query
in ESSENCE for chicken pox or varicella in the
chief complaint and contacted the hospital to
verify if the case was confirmed and should be
reported - Although staff has also performed individual
disease-related chief complaint queries
occasionally during outbreaks or mass gathering
events we sought to enhance our capabilities on a
daily basis and look at a wider range of diseases
6Methods
- Since March 2008, MDCHD has performed specialized
daily chief complaint queries for 20 reportable
diseases and since October 2008, we now search
for 75 diseases/conditions - The original 20 queries included chicken pox,
malaria, meningitis, cyclosporiasis,
cryptosporidiosis, ciguatera, mumps, pertussis,
hepatitis, encephalitis, botulism, smallpox,
shigellosis, salmonellosis, anthrax, dengue
fever, measles, mercury or food poisoning, or
exposure - An additional query is conducted for diarrhea and
vomiting
7Methods
- We aimed to show how
- ESSENCE can be used in
- the following situations
- 1) Underreported diseases/
- conditions (i.e. Chicken pox)
- 2) Serious/time-sensitive diseases
- (i.e. Category A bioterrorism agents,
- meningitis)
- 3) Possible outbreaks
8Methods
- When descriptions of the queried diseases are
found in the chief complaint, MDCHD staff
investigates each one individually and excludes
those that are irrelevant to the search - When it is suspected that the chief complaint may
be a valid case, staff then contact the Infection
Control Practitioner (ICP) of the hospital - Staff follow up until the disease is confirmed
and entered into the State of Florida electronic
disease reporting system, Merlin
9Methods
- Findings in ESSENCE queries from March to October
2008 were compared to previous years and to
Merlin and the MDCHD Animal Bite Database.
10Results
Disease/Conditions found in a specialized query
in ESSENCE, March- October 2008
- From March to October 2008, there were 582,463
ED visits (mean of 2,447 per day) - There were a total of 1,242 (0.2) ED visits
that had one of the 20 queried reportable disease
in the chief complaint (mean of 5 per day) and
660/1,242 (53) were relevant
11Results
Disease/Conditions found in a specialized query
in ESSENCE, March- October 2008
12Results
1) Underreported diseases/conditions
- Chicken pox investigation
- After excluding those that were irrelevant, there
were 205 ED visits for possible chicken pox
between Jan 2006 and Dec 2007. However, 43 were
reported in Merlin during those two years. - After the implementation of the specialized
query, there were 58 ED visits for possible
chicken pox between March and October of 2008 and
48 were reported in Merlin during those 8 months.
- Note cases in Merlin also are from private
providers and not only from EDs
13Results
1) Underreported diseases/conditions
- Rabies PEP investigation
- In Florida, only animal bites that lead to the
administration of post-exposure prophylaxis (PEP)
for rabies are reportable in Merlin - To assess the quality of animal bite
surveillance, animal bites and rabies in ESSENCE
were compared to MDCHDs Animal Bite database and
Merlin - The query included the following words rabies,
dog, bite, animal, etc - The MDCHD Animal Bite database includes reports
from hospitals, the Miami-Dade County Animal
Services Department, veterinarian clinics and
community residents
14Results
1) Underreported diseases/conditions
ED visits and reported cases of post-exposure
prophylaxis for rabies, 2006 - 2008
- From 2007 2008, there was a 47 increase in
reporting of post-exposure prophylaxis for rabies
since the specialized query was implemented - Note Cases in Merlin also are from private
providers and not only from EDs
15Results
- 2) Serious/time-sensitive diseases
- Meningitis investigation
- ED visits with meningococcemia in the chief
complaint, August 31, 2008
- These cases did not initiate an alert and
therefore without the query the health - department would not have been aware about the
case - The health department contacted the ICP and
assisted with calling all the possible - contacts to ensure they were provided the
appropriate prophylaxis
16Number of meningitis chief complaints found in
the specialized query, all Miami-Dade County EDs,
March October 2008
Number of meningitis chief complaints found in
the specialized query at 1 hospital ED, March
October 2008
17Results
- 3) Possible outbreaks
- Outbreak investigation in a homeless shelter
- Between June 14 and 17, 2008, three small
clusters by resident zip code and ED - visit time were detected in a southern Miami-Dade
County hospital with diarrhea and/or - vomiting as chief complaints
- After staff contacted the ICP, It was discovered
that 12 ill individuals from the same - Zip code arrived from the same homeless shelter
over several days
Spatial-Temporal and Chief Complaint Clustering
in an Emergency Department
18Results
3) Possible outbreaks
- Since a gastrointestinal illness alert was not
automated because of the small number - of persons involved, this demonstrates how
important it is to carefully monitor - all clusters and not only those automatically
created by the system.
Daily ED Visits with Chief Complaints of
Diarrhea/Vomiting in Zip Code 33033, 6/1 -
6/20/2008
Daily ED Visits to Hospital A with Chief
Complaints of Diarrhea/Vomiting, 6/1 -
6/20/2008
19Results
3) Possible outbreaks
20Conclusions
- This study verified that ESSENCE can be useful
not only in providing an early warning of unusual
outbreaks in the community but also for ensuring
that healthcare practitioners report diseases
appropriately - Due to the fact that only a small percentage of
chicken pox and post-exposure prophylaxis for
rabies cases were reported, this approach can
improve quality control measures for
underreported conditions - By contacting the ICP when reportable disease
names are found in the chief complaint, MDCHD has
developed a stronger relationship with hospitals
21Conclusions
- Staff will continue to use these specialized
search methods on a daily basis and hopefully
better compliance will result through this use of
syndromic surveillance - A limitation for smaller health departments may
be the limited staff and resources to investigate
- In addition, staff will also provide healthcare
practitioners with information about the
reportable disease list via email, phone, mail,
and on-site hospital visits
22Acknowledgements
- Dr. Guoyan Zhang
- Lizbeth Londono
- Anthoni Llau
- Rene Borroto-Ponce
- MDCHD Surveillance Staff