OTC Medication Sales for Syndromic Surveillance: How Useful Is It?

2. Syndromic Surveillance Using OTC Medication Sales…How 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

3. 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 gov’t levels and pharmacists

4. On the Agenda… • OTC data surveillance • Public Health Agency of Canada’s (PHAC) use of OTC data • Features & Utility • Challenges • Advantages

5. OTC Data Surveillance

6. A. S. A .P. Alternative Surveillance Alert Project https://www.cnphi-rcrsp.ca/cnph

7. Early warning of community outbreaks. Investigate significant historical Canadian outbreaks. • Waterborne : • Walkerton, Ontario E.coli O157 and Campylobacter • Battlefords, Saskatchewan Cryptosporidium

8. Walkerton, Ontario Spring 2000 Waterborne outbreak: E.coli O157 and Campylobacter

9. A. S. A .P. Alternative Surveillance Alert Project • 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 IGI–related ER visits data

10. Start of outbreak period 13th May Culture confirmed cases (onset+4days) and Weekly Totals of OTC Walkerton, March-June 2000 Ref: Edge et al., 2004. Can J Pub Health 95(6):446-450

11. Battlefords, Saskatchewan Spring 2001 Waterborne outbreak: Cryptosporidium

12. APR 25 Boil Water Advisory APR 25 Boil WaterAdvisory (n=110) MAR 21 Water system compromised MAR 21 Water system compromised 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

13. A. S. A .P. Alternative Surveillance Alert Project How PHAC uses OTC data

14. A. S. A .P. Alternative Surveillance Alert Project • 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

15. A. S. A .P. Alternative Surveillance Alert Project • PHAC’s 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

16. Features & Utility

17. Web-based Data Collection, Analysis and Reporting https://www.cnphi-rcrsp.ca/cnph “Canadian Early Warning System” (CEWS)

18. 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

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

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

21. Challenges…and Advantages What’s the Word at the Public Health Region Water Cooler?

22. “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.“

23. With thanks: Dr. Hazel Lynn, Alanna Leffley Grey Bruce Health, ECADS research team - OTTAWA HOWEVER,… In combination with other information…

24. A final comment… The very process of investigating OTC sales-based surveillance has increased the level of communication between pharmacy and public health officials.

25. 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