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INFLUENZA SURVEILLANCE IN SAN DIEGO COUNTY

INFLUENZA SURVEILLANCE IN SAN DIEGO COUNTY. Jeffrey Johnson, MPH. Senior Epidemiologist Epidemiology & Immunization Services Branch (EISB) Public Health Services. Influenza Detection & Surveillance. World. U.S. San Diego County. California. Influenza in the local news – January 2013.

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INFLUENZA SURVEILLANCE IN SAN DIEGO COUNTY

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  1. INFLUENZA SURVEILLANCE IN SAN DIEGO COUNTY Jeffrey Johnson, MPH Senior Epidemiologist Epidemiology & Immunization Services Branch (EISB) Public Health Services

  2. Influenza Detection & Surveillance World U.S. San Diego County California

  3. Influenza in the local news – January 2013 Source: UT San Diego

  4. San Diego County Influenza Surveillance • All year round • Influenza lab result reporting • Sentinel sites: rapid flu tests and ILI • Influenza death reporting and tracking • Syndromic surveillance ILI (local system & BioSense) • EMS transports (local system) • 911 calls (Firstwatch) • P&I deaths trends • Collaborative information sources • Navy, CA & CDC Border Health, Mexico, social media • Distribution of reports, alerts, etc.

  5. San Diego County Reports & Updates • Weekly Influenza Watch report e-mailed to interested people • Regular alerts and updates through CAHAN (California Health Alert Network) • Information used in county reports and press releases

  6. INFLUMATICS Community Awareness & Circulating Virus Progressing Illness Outpatient & Hospitalization Absenteeism Death Influenza Surveillance Data Sources • Baseline trends • New incidents • Vaccinations • Flu strains • Healthcare capacity • Situational awareness • Animal influenza • School • Work • Staffing levels • Clinic • Urgent care • ED visits • ICU cases • Clinical Dx • Lab tests • Prescriptions • Death certificates • Autopsy • ILI • Self-medicating • Self-monitoring • Nurse hotline • 911 calls • EMS transports

  7. Are we speaking the same ILI language? Cough with fever Difficulty breathing with fever

  8. ILI Surveillance in San Diego County

  9. San Diego CountyED Syndromic Surveillance ILI • Emergency department data • Chief complaints • Syndrome categories • Respiratory • ED Flu like • Text parsing • A chief complaint must contain both a “respiratory” and “fever” component • Many different text options possible

  10. San Diego CountyED Syndromic Surveillance ILI cont. Example text parsing into ILI • “flu symptoms” • “URI with fever” • “coughing with fever” • “487.1” • “runny nose with fever” • “h/a, cold with fever”

  11. vs. Clinician Reporting of ILI Syndromic Surveillance

  12. BioSense 2.0 ILI Trends, 2012–13FY Selected ILI for SD (only), all visits, 7/1/2012 to 6/29/13 (weeks 27–26)

  13. Initial Results x Day

  14. Basic Comparison of BioSense ILI vs. Local Syndromic Surveillance BioSense 2.0 Local Syndromic ILI

  15. What about Meaningful Use Data? • HL7 messages – ADT A01, A03, A04, A05, A08 • OBX segment contains the temperature • Demographics MSH|^~\&|EPIC|…....  EVN|A03|20131023143659|……..  …. ….  PV1|1|EMERGENCY|……… OBX|1|……..   OBX|2|………   OBX|3|NM|MUPTAGE|3|8||||||F   OBX|4|NM|MUPTTEMP|4|104.2||||||F   DG1|1|ICD-9-CM|487.1^Influenza with other respiratory manifestations^ICD-9-CM|… Emergency department discharge diagnosis of an 8 year old with a temperature of 104.2 and diagnosis of influenza

  16. 06/26/2013 San Diego County Syndromic Surveillance Data Flow Hospitals 06/26/2013 Atlas Development Corp County contracted messages broker San Diego Health Connect HIE SFTP ASCII Files Legend HL7 2.3 (Kaiser) Public Health Services Syndromic Surveillance SDHC HIE HL7 2.5 SDHC HIE HL7 2.5 (in progress) CDC From BioSense To BioSense (county aggregate)

  17. Concluding Thoughts • ILI is a common population health indicator • ILI can apply to many different data sources • ILI, by definition, is hard to standardize • ILI is one of several key influenza surveillance components • ILI can be useful for surge capacity benchmarks • Syndromic MU-ILI data may have greater specificity and standardization potential

  18. THANK YOU For More Information Jeffrey.johnson@sdcounty.ca.gov 619-692-8448 Jeffrey Johnson

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