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Disease Surveillance in NYS

Disease Surveillance in NYS. Jim Miller, MD, MPH Director, Bioterrorism Epidemiology New York State Department of Health jrm17@health.state.ny.us. Traditional and Syndromic Surveillance. Traditional notifiable disease surveillance

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Disease Surveillance in NYS

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  1. Disease Surveillance in NYS Jim Miller, MD, MPH Director, Bioterrorism Epidemiology New York State Department of Health jrm17@health.state.ny.us

  2. Traditional and Syndromic Surveillance • Traditional notifiable disease surveillance • Relies on patient seeking medical care, laboratory test being ordered and laboratory/clinician reporting • Reporting lag is typically days to weeks • “Syndromic” surveillance • Tracking non-specific symptoms or health “events” (sale of diarrhea medication) • “Real time” (within hours)

  3. Reportable Diseases in NYS

  4. Syndromic Surveillance Goals • Recognize an outbreak due to a natural cause or a terrorist agent earlier than physician, laboratory or citizen reporting. • Monitor general community health – track level of disease. • Provide objective evidence that an outbreak is not occurring. • Help sustain a strong ongoing relationship between public health and clinical medicine.

  5. Background • Syndromic surveillance can detect outbreaks. • Syndromic surveillance is a supplement to traditional disease reporting. • Statistically significant signals must be verified clinically to determine public health significance. • Inter-system comparisons may help in the interpretation of a positive signal. • Although a promising approach, there is insufficient experience to evaluate if syndromic surveillance improves public health response.

  6. Syndromic Surveillance Systems Operated by NYSDOH(Emergency Department Data) * Electronic Clinical Laboratory Reporting System

  7. Syndromic Surveillance Systems Operated by NYSDOH(Pharmacy Data) *Data available to counties registered at National site: http://rods.health.pitt.edu/NRDM.htm

  8. Medicaid SystemLong Term Trend Report CountyABC

  9. Source: F Mostashari, NYCDOHMH.

  10. Biosurviellance • BioWatch • Biohazard Detection System (BDS)

  11. BioWatch • 500 sensors in 31 cities • Outdoor air samples every 12-24 hours • Laboratory testing for biological agents • Confirmed sample will initiate mass clinics Source: Miami Herald, 14 Nov 2003

  12. Biohazard Detection System (BDS) • Free-standing PCR-based technology • Samples air continuously above mail-sorting machines at large USPS facilities • Test initiated every 60 minutes • Testing takes ~30 minutes • Limited to Bacillus anthracis • Positive “signal” leads to automatic alarm, work area evacuation, worker “decontamination” • If BDS verified by LRN PCR testing, antibiotic distribution within 15 hours of presumed exposure, vaccination following culture confirmation • No positive signals (yet)

  13. Biohazard Detection System Source: http://www.lunewsviews.com/usps/pcr.htm

  14. Responding to a BDS Signal BDS Signal Pre-positioned Meds Collect employee data Sample to LRN 0-8 hours 2 cartridges, liquid reserve Antibiotic distribution plan in “watch” mode Employee shower/wash; change clothes Positive LRN PCR Negative LRN PCR Alert employees and public now off-site Distribute 3-10-day course of antibiotics for all exposed persons 9-15 hours Notify USPS Collect epi data Initiate environmental sampling to find source of contamination Confirmed LRN Culture Negative LRN Culture 60-day antimicrobial prophylaxis and vaccination for selected employees Isolate sent to CDC for antibiotic sensitivity 16-120 hours Collect epi data (upstream analysis) Source: CDC, with modifications by NYSDOH

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