Enhanced health event detection and influenza surveillance using a joint Veterans Affairs and Department of Defense biosurveillance application

<p>Abstract</p> <p>Background</p> <p>The establishment of robust biosurveillance capabilities is an important component of the U.S. strategy for identifying disease outbreaks, environmental exposures and bioterrorism events. Currently, U.S. Departments of Defense (DoD) and Veterans Affairs (VA) perform biosurveillance independently. This article describes a joint VA/DoD biosurveillance project at North Chicago-VA Medical Center (NC-VAMC). The Naval Health Clinics-Great Lakes facility physically merged with NC-VAMC beginning in 2006 with the full merger completed in October 2010 at which time all DoD care and medical personnel had relocated to the expanded and remodeled NC-VAMC campus and the combined facility was renamed the Lovell Federal Health Care Center (FHCC). The goal of this study was to evaluate disease surveillance using a biosurveillance application which combined data from both populations.</p> <p>Methods</p> <p>A retrospective analysis of NC-VAMC/Lovell FHCC and other Chicago-area VAMC data was performed using the ESSENCE biosurveillance system, including one infectious disease outbreak (Salmonella/Taste of Chicago-July 2007) and one weather event (Heat Wave-July 2006). Influenza-like-illness (ILI) data from these same facilities was compared with CDC/Illinois Sentinel Provider and Cook County ESSENCE data for 2007-2008.</p> <p>Results</p> <p>Following consolidation of VA and DoD facilities in North Chicago, median number of visits more than doubled, median patient age dropped and proportion of females rose significantly in comparison with the pre-merger NC-VAMC facility. A high-level gastrointestinal alert was detected in July 2007, but only low-level alerts at other Chicago-area VAMCs. Heat-injury alerts were triggered for the merged facility in June 2006, but not at the other facilities. There was also limited evidence in these events that surveillance of the combined population provided utility above and beyond the VA-only and DoD-only components. Recorded ILI activity for NC-VAMC/Lovell FHCC was more pronounced in the DoD component, likely due to pediatric data in this population. NC-VAMC/Lovell FHCC had two weeks of ILI activity exceeding both the Illinois State and East North Central Regional baselines, whereas Hines VAMC had one and Jesse Brown VAMC had zero.</p> <p>Conclusions</p> <p>Biosurveillance in a joint VA/DoD facility showed potential utility as a tool to improve surveillance and situational awareness in an area with Veteran, active duty and beneficiary populations. Based in part on the results of this pilot demonstration, both agencies have agreed to support the creation of a combined VA/DoD ESSENCE biosurveillance system which is now under development.</p

Barriers to the Influenza Vaccination in Veterans

Influenza is the eighth leading cause of death in the United States, accounting for 56,000 deaths annually and leading to an average of more than 200,000 hospitalizations every year. Adults 65 years of age and older account for 50% to 60% of influenza-related hospital admissions and an estimated 90% of influenza-associated deaths occur in people age 65 and older. During the 2011 to 2012 influenza season, approximately 50 % of veterans between 45 and 70 years of age refused the influenza vaccine within the metro-area outpatient Veteran Administration (VA) facility in Atlanta, Georgia. The aim of this project was to identify and to identify barriers to influenza vaccinations in veterans. The health belief model was utilized to organize the evidence-based practice data obtain from the literature reviews on the barriers to the influenza vaccine. An Influenza vaccination educational pamphlet was developed using data obtained from the literature reviews. No information was obtained from the veterans. The educational pamphlet listed the identified barriers and ways to overcome the barriers to the influenza vaccination. The influenza vaccination educational pamphlet will be utilized by veterans and staff in the outpatient clinic. The pamphlets will to be placed in the veteran\u27s waiting areas, medication rooms, and lobby areas prior to the beginning of the influenza season at the end of September. The organization\u27s outpatient quarterly influenza data report will be utilized to disseminate the results to the educational tool\u27s effectiveness after implementation at the end of the influenza season in May. The social impact of solving this issue is the opportunity to decrease the major infrastructure demands placed on the healthcare system as well as human suffering caused by influenza

Improving public health preparedness : strengthening biosurveillance systems for enhanced situational awareness

This report is designed to aid state, territorial, tribal, and local public health leaders as they improve their capacity to achieve situational awareness during a public health emergency. We intend this report to serve as a concise reference work public health leaders can use to help design and manage biosurveillance systems to be used during an anticipated public health emergency. We hope public health staff will find it helpful in answering the question, \u201cWhat information do I need to support decision making during a public health emergency and how do I get this information?\u201d To address this question, we focused on information needs for situational awareness using three scenarios: a mass gathering, a natural disaster, or a large outbreak.During these events, information on population health status, health risks, and health services must be readily available to those managing the public health response to the event (Figure 1). This report lists \u201ccore\u201d information needed to effectively manage the public health aspects of an event such as an outbreak, a natural disaster, or a mass gathering. Furthermore, the report describes guiding principles and system capabilities that assure surveillance information systems meet relevant standards, while addressing the need for flexibility to adapt to unique and changing circumstances.We intend for the report\u2019s findings and recommendations to be used by CDC grantees to prioritize activities related to the use of Public Health Emergency Preparedness (PHEP) funding (as well as funding from other CDC cooperative agreements) in the development, maintenance, and optimization of biosurveillance systems. In particular, we intend that our findings and recommendations will delineate specific action steps which will complement and supplement existing guidance contained in the recently developed PHEP capabilities.This research was carried out by the North Carolina Preparedness and Emergency Response Research Center (NCPERRC) at the University of North Carolina at Chapel Hill\u2019s Gillings School of Global Public Health and was supported by the Centers for Disease Control and Prevention (CDC) Grant 1PO1 TP 000296.BiosurvReport_092013.pdfgrant 1PO1 TP00029