Harold H. Collins Information Technology Specialist

1. Epi Info™ Health Surveillance Use Public Health Software for MicrosoftWindows 98, 2000, XP, Vista, and Windows 7 Harold H. Collins Information Technology Specialist Epi Info™ Health Surveillance Use Korean Public Health Surveillance Conference 31 March 2011 Office of Surveillance, Epidemiology, and Laboratory Services Epidemiology and Analysis Program Office

2. Epi Info™ Health Surveillance Use Cases • Epi Info™ Viral Hepatitis Surveillance System? • Background of Use Cases • Objectives of the surveillance system • Surveillance system design using Epi Info™ • Outcome of system deployment • Community Assessment for Public Health Response (CASPER) • Background of Use Cases • Objectives of the assessment system • Assessment system design using Epi Info™ • Outcome of system deployment • Other Use Cases • Questions

3. Jaundice Surveillance Background • One of the largest HEV epidemics in Africa was identified in 2008. This outbreak resulted in more than 10,000 cases and 160 deaths recorded by December 2008. • A ministry of health requested the Division of Viral Hepatitis (DVH) at the U.S. Centers for Disease Control and Prevention (CDC) to assist with investigation of this HEV epidemic. • After the initial investigation and report, the ministry of health, cognizant of the prevailing situation and interested in other lingering questions, invited DVH to monitor the current status of HEV infection by establishing a jaundice surveillance system.

4. Objectives of the Surveillance System • Three primary objectives of the surveillance system • Enumerate acute jaundice cases • Determine age and geographic distribution • How widespread is the infection in the survey region • Determine what proportion of acute jaundice cases is attributable to HEV • Collect laboratory data for each case • Anti-HEV IgM • Anti-HAV IgM • Anti-HCV • Assess the current magnitude of HEV as a public health problem • Anti-HEV IgM and Anti-HEV IgG immunoglobulin levels • Report of total cases by Epi week

5. Surveillance System Design • The two teams worked together to refine the requirements • Two Epidemiologist • Two Information Technology Specialist • Information Technology Team • Developed the forms, menus, analysis, and system reports • Tested menus and system function • Created a detailed 16-page instruction manual • Epidemiology Team • Tested the surveillance system • Deployed system to the region and provided user training • Collected and analyzed resulting data

6. Outcome of System Deployment • The Jaundice Surveillance is in use today • Data is regularly sent to the epidemiologist • Data is being analyzed to monitor the magnitude of HEV as a public health problem • The ministry of health is kept cognizant of the prevailing situation

7. CASPER Background • The Community Assessment for Public Health Response (CASPER) model is used to assist local and regional health departments in responding to natural disasters in their communities. • The objective of a community assessment is to document population-based needs following a natural disaster or manmade disaster. This method has been successfully used in responding to hurricanes, floods, and ice storms. • After the initial questionnaire development the Epi Info Team was asked to use the existing questionnaire to develop an electronic Epi Info data input form.

8. Objectives of the Assessment System • The primary objectives of the Assessment system • Identify health and service needs and hazards that might not be immediately obvious • Safe food and water supplies • Sources of power (e.g., gas, electricity) • Communication services (e.g., telephone, radio) • Medical and public health care for both acute and chronic conditions • Target relief efforts at the people who need them most • Identify which needs have been successfully met • Mortality surveillance and reporting

9. Assessment System Design • Initial assessment form designed by state health department • Epi Info™ Team asked to create Epi Info electronic data entry forms • Form designed by the Epi Info™ Team • State health department users tested the forms • Assessment system used to collect data and perform Ad hoc reports • Development of menus and standard report are a possible addition to the system

10. Assessment System Use • The system is used by the state health department • System runs on any windows personal computer • It is ready for deployment any time a natural or manmade disaster strikes • Floods • Earth quakes • Hurricanes • Wild fires • Ice storms

11. Other Use Cases • CDC Influenza Sentinel Surveillance System • Early detection of Influenza outbreak • Identify Influenza strains • Routine Immunization and Data Management • Collect and feed-forward immunization data • Monitor quality of data through routine reports • Surveillance System for Polio eradication • Collect immunization data • Identify wild Polio cases • Social Violence Survey System • Detect and document rates of social violence • Develop better understanding for improved intervention programs

12. More Use Cases • Assessment of Mercury (Hg) Exposure in a Puerto Rican High School, January 2011 • How many were exposed to the Hg • If they had any signs or symptoms related to Hg toxicity and how long have they had the symptoms • Epi Info analysis demonstrated no correlation of symptoms and Hg levels • This spill did not cause harmful health effects on the exposed population • Johns Hopkins Bloomberg School of Public Health 2010, Johnson & Johnson Community Health Care Program • Implementing programs using Epi Info to prevent obesity and prevent or manage related chronic diseases such as diabetes

13. CDC Epi Info™ Team • José Aponte Training Coordinator • David Brown Epi Info™ 7 Developer • Harold Collins Community Liaison • James Haines Epi Info™ 7 Developer • Asad Islam Epi Info™ Team Lead • Erik Knudsen Epi Info™ Help Desk • Roger Mir Custom Applications • David Nitschke Epi Info™ Technical Lead • Epi Info™ Help Desk (epiinfo@cdc.gov)

14. Resources and Technical Support • Download and install the latest Epi Info™ program from the website at http://www.cdc.gov/epiinfo • Helpline epiinfo@cdc.gov or call 404.498.6190 • Additional training resources are available online at: http://wwwn.cdc.gov/epiInfo/html/tutorials.htm • Epi Info™ Community of Users in phConnects http://www.phconnect.org/group/epiinfo • Send your comments and suggestions to hcollins@cdc.gov or epiinfo@cdc.gov

15. Questions? The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Office of Surveillance, Epidemiology, and Laboratory Services Epidemiology and Analysis Program Office