Syndromic Surveillance Using OTC Medication Sales

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Syndromic Surveillance Using OTC Medication
SalesHow Useful Is It? Victoria L.
Edge Foodborne, Waterborne and Zoonotic
Infections Division Infectious Disease and
Emergency Preparedness COMOH/APHEO Education
Session for Syndromic Surveillance 1st February
2007
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Objectives
A. Understand how OTC data are collected and
categorised the importance of researching
historical data.
B. Understand the difference between using
spatio-temporal patterns of OTC sales as an early
warning system and for routine surveillance.
C. Understand the role of, and interactions
between, public health representatives at
different govt levels and pharmacists
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On the Agenda

• OTC data surveillance
• Public Health Agency of Canadas (PHAC) use of
  OTC data
• Features Utility
• Challenges
• Advantages

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OTC Data Surveillance
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Early warning of community outbreaks. Investigate
significant historical Canadian outbreaks.

• Waterborne
• Walkerton, Ontario E.coli O157 and Campylobacter
• Battlefords, Saskatchewan Cryptosporidium

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Walkerton, Ontario Spring 2000 Waterborne
outbreak E.coli O157 and Campylobacter
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• Meeting with area pharmacists and PHU
  representatives
• Collection of data only one pharmacy able to
  provide electronic data (in weekly format)
• Compared with confirmed (lab) cases from
  outbreak investigation and also with IGIrelated
  ER visits data

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Culture confirmed cases (onset4days) and Weekly
Totals of OTC
Walkerton, March-June 2000
Ref Edge et al., 2004. Can J Pub Health
95(6)446-450
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Battlefords, Saskatchewan Spring 2001 Waterborne
outbreak Cryptosporidium
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North Battleford, Saskatchewan Spring 2001
OTC medications related to IGI epidemic curve
realized in a retrospective investigation of a
waterborne outbreak of Cryptosporidium.
(Ref Stirling R, et al. 2001. )
http//www.health.gov.sk.ca/info_center_pub_health
_can_epi_report_NB.pdf
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How PHAC uses OTC data
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• Key Observations from Initial Research
• Keep human involvement to a minimum
• Keep it simple for public health officials
• for retailers and pharmacists
• Define benefit for public health
• for retailers and pharmacists

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• PHACs Objectives
• Create and test a system of OTC-sales based
  surveillance operating at the national level
• Collect data electronically automatically from
  major retailers
• Feed all data electronically into one location
• Analyse at different jurisdictional levels as
  required

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Features Utility
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Web-based Data Collection, Analysis and Reporting
https//www.cnphi-rcrsp.ca/cnph
Canadian Early Warning System (CEWS)
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• Currently
• 6 (almost 7!) major retailers providing data for
  all of their locations across Canada (2200
  locations representing 50 of all major
  retailers pharmacies)
• PHAC providing wkly reports/alerts to pilot PHUs
• Pilot PHU users have access to web-based
  monitoring (via CNPHI-CEWS)
• Interaction with PH officials and Pharmacy reps

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• DATA
• UPC level daily sales volumes by pharmacy
  location
• Adult and Paediatric
• anti-diarrhoeal, anti-nauseant, rehydration
• cough and cold products, vaporisers,
  thermometers

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• TO DO
• Enlist more retailers
• Evaluate on-line system by PH pharmacy
  officials in next year

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Challengesand Advantages Whats the Word at the
Public Health Region Water Cooler?
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OTC data are not that useful for primary
detection.
ER visit data are better at earlier detection of
disease outbreaks.
OTC data are non-specific.
Rural areas are poorly represented (if at all)
by OTC data.
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HOWEVER, In combination with other information
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A final comment The very process of
investigating OTC sales-based surveillance has
increased the level of communication between
pharmacy and public health officials.
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• Acknowledgements
• Public Health Agency of Canada (esp. P Muchaal, J
  Aramini, S Mukhi)
• Walkerton area pharmacists (esp. K. Brown)
• Public Health Units Grey-Bruce,
  Wellington-Dufferin-Guelph, Kingston Frontenac
  Lennox Addington, Waterloo Region, City of
  Hamilton, Winnipeg Region)
• CRTI funding for CNPHI
• PharmaPlus and Rexall (KATZ Group Canada Ltd),
  Shoppers Drug Mart, Wal-Mart, Loblaw, London
  Drugs, Safeway
• Canadian Association of Chain Drug Stores (CACDS)
• University of Guelph
• ECADS and the Grey Bruce Health Unit