Houston Health Department’s response to the threat of Zika virus

ObjectiveThis session will explore the role of the Houston Health Department(HHD) in the City of Houston’s response to the threat of Zika. Thepanelists will provide perspective from the roles of Bureau Chief,informatician, and epidemiologist and provide insight into lessonslearned and strategic successes.IntroductionZika virus spread quickly through South and Central America in2015. The City of Houston saw its first travel-related Zika cases inDecember of 2015. On January 29th, the City held the first planningmeeting with regional partners from healthcare, blood banks,petrochemical companies, mosquito control, and others. Additionallythe City activated Incident Command Structure (ICS) and designatedthe Public Health Authority as the Incident Commander.Initial steps taken by HHD included expanding the capabilityand capacity of the public health laboratory to test for Zika virus;expand surveillance efforts; created an educational campaign aroundthe “3Ds” of Zika defense (Drain, Dress, DEET) which were thendisseminated through several means, including a mass mailing withwater bills; and provided DEET to mothers through the WIC program.The Houston Health Department took the lead in authoringthe City’s Zika Action Plan. In this 3 goals and 6 strategies wereidentified. Goals included 1) Keep Houstonians and visitors aware ofthe threat of Zika; 2) minimize the spread of the virus; and 3) protectpregnant women from the virus. The 6 strategies employed were toA) develop preparedness plans; B) implement ICS within the City;C) ensure situational awareness through surveillance; D) Increasecommunity awareness; E) reduce opportunities for Zika mosquitobreeding grounds; and F) provide direct intervention to reduce thethreat of Zika.HHD was responsible for many of the action items within theplan. We conducted several community outreach events, where wedisseminated educational materials, t-shirts, DEET, and other give-aways. These events allowed frequent engagement with the public forbidrectional communication on how to approach the threat

Houston Health Department’s response to the threat of Zika virus

ObjectiveThis session will explore the role of the Houston Health Department(HHD) in the City of Houston’s response to the threat of Zika. Thepanelists will provide perspective from the roles of Bureau Chief,informatician, and epidemiologist and provide insight into lessonslearned and strategic successes.IntroductionZika virus spread quickly through South and Central America in2015. The City of Houston saw its first travel-related Zika cases inDecember of 2015. On January 29th, the City held the first planningmeeting with regional partners from healthcare, blood banks,petrochemical companies, mosquito control, and others. Additionallythe City activated Incident Command Structure (ICS) and designatedthe Public Health Authority as the Incident Commander.Initial steps taken by HHD included expanding the capabilityand capacity of the public health laboratory to test for Zika virus;expand surveillance efforts; created an educational campaign aroundthe “3Ds” of Zika defense (Drain, Dress, DEET) which were thendisseminated through several means, including a mass mailing withwater bills; and provided DEET to mothers through the WIC program.The Houston Health Department took the lead in authoringthe City’s Zika Action Plan. In this 3 goals and 6 strategies wereidentified. Goals included 1) Keep Houstonians and visitors aware ofthe threat of Zika; 2) minimize the spread of the virus; and 3) protectpregnant women from the virus. The 6 strategies employed were toA) develop preparedness plans; B) implement ICS within the City;C) ensure situational awareness through surveillance; D) Increasecommunity awareness; E) reduce opportunities for Zika mosquitobreeding grounds; and F) provide direct intervention to reduce thethreat of Zika.HHD was responsible for many of the action items within theplan. We conducted several community outreach events, where wedisseminated educational materials, t-shirts, DEET, and other give-aways. These events allowed frequent engagement with the public forbidrectional communication on how to approach the threat

Disaster Surveillance: Perspectives from Federal, State, and Local levels

ObjectiveIn this panel, attendees will learn about how disaster surveillance was conducted in response to Hurricanes Irma and Harvey, as well as the role of CDC at the federal level in supporting local response efforts. By hearing and discussing the challenges faced and solutions identified, attendees will be better able to respond in the event of a low-frequency/high-consequence disaster occurring within their jurisdiction.IntroductionIn this panel, the presenters will discuss their perspective in responding to Hurricanes Harvey and Irma. Hurricane Harvey made landfall on August 25th and over the course of 4 days dropped approximately 27 trillion gallons of water on Texas and Louisiana.1 The flooding that ensued was unprecedented and forced over 13,000 people into shelters.2 These individuals needed to have their basic needs -food, shelter, clothing, sanitation- met as well as their physical and mental health needs. The George R Brown Conference Center (GRB) and NRG Stadium Center were set up as mega-shelters to house shelterees. Hurricane Irma made landfall on September 10th in the Florida Keys as a Category 4 Hurricane. The Hurricane caused 72 deaths3 and forced thousands of people into shelters.4 These weather events created novel challenges for local response efforts. Decision makers needed timely and actionable data, including surveillance data.DescriptionAt the federal level, Aaron Kite-Powell will discuss his experiences in supporting local efforts to acquire timely and actionable data collected by on-site federally deployed disaster medical assistance teams (DMAT). DMAT provided clinical services to residents who were staying in a mega-shelter. Data collected from DMAT was electronically sent to CDC through the National Syndromic Surveillance Program (NSSP) where it could be accessed in CDC's instance of ESSENCE. Additionally, in Houston, 3 area hospitals submitted their data to NSSP. The City of Houston Health Department (HHD) was given access to DMAT and hospital syndromic data through ESSENCE. Once access was established, just in time training was conducted for HHD.David Atrubin will discuss how Florida’s syndromic surveillance system was utilized during Hurricane Irma in September 2017. ESSENCE-FL provided critical near real-time surveillance data before, during, and after the storm. Multiple data sources, within the ESSENCE-FL, were utilized including emergency department, poison control, death record, and DMAT data. In addition to the anticipated increases in animal bites, injuries, medication refills, dialysis visits, and carbon monoxide exposures, some unexpected increases were observed as well.Eric Bakota will describe his experience in coordinating the remote shelter surveillance team for the City of Houston Health Department. In the immediate aftermath of the flooding, several organizations opened shelters for people who were forced to leave their homes. Many of these facilities were not officially connected to the City. An ad hoc process was used to identify and connect with these facilities. Once identified as a shelter, a team of 6 epidemiologists conducted daily check-ins to determine the census and status of shelterees. Several tools to coordinate activities and record the data collected were used, including Dropbox, Googlesheets, and MAVEN. Each tool had its own strengths and limitations that will be discussed.How the Moderator Intends to Engage the Audience in Discussions on the TopicThe moderator should engage the panelists by asking questions the following questions:● How did each panelist work with their Federal/State/Local partners● How did each panelist integrate into the larger response framework (e.g., ICS)● How did each panelist use technology to address any novel surveillance barriers during the disasterReferences1. Sanchez R, Yan H, Simon D. Harvey aftermath: Houston 'open for business'; other cities suffering. CNN. 2017 Sep 1.2. Sullivan K, Hernandez A, Fahrenthold D. Harvey leaving record rainfall, at least 22 deaths behind in Houston. Chicago Tribune. 2017 Aug 29.3. Impact of Hurricane Irma. Boston Globe. Accessed 2017 Oct 10. https://www.bostonglobe.com/news/bigpicture/2017/09/11/impact-hurricane-irma/W6WBN9K2lXd4gPmtu26auN/story.html4. Smith A. After Hurricane Irma, Many Ask: How Safe Are Shelters? Tampa Bay Times. 2017 September 21.

Estimating FluNearYou Correlation to ILINet at Different Levels of Participation

Once approximately 200 participants are registered and active, Flu Near You data can inform local officials of current influenza activity

Jurisdictional Etiquette Workgroup: An offshoot of a Syndromic Surveillance Consortium

Objective● To demonstrate the importance of a cross-jurisdictional etiquette workgroup in the Texas Southeast region that leverages on the Syndromic Surveillance Consortium● To promote data sharing and communicate the findings of disease to assist rapid investigation and data sharingKey words:ESSENCE (Electronic Surveillance System for Early notification of Community-based Epidemics)IntroductionSyndromic data is shifting the way surveillance has been done traditionally. Most recently, surveillance has gone beyond city limits and county boundary lines. In southeast Texas, a regional consortium of public health agencies and stakeholders in the 13-County area governs the local ESSENCE system. The Houston Health Department, (HHD) is responsible for deploying ESSENCE to the entire region.To effectively monitor the health of the region’s population, a need arose to establish clear guidelines for disease investigation and data sharing triggered by syndromic surveillance across the area. Since Houston’s instance of ESSENCE serves all 13 counties, the consortium instituted a cross- jurisdictional etiquette group. The purpose of the group is to determine the standard protocol for responding to ESSENCE alerts and best practices for data sharing and use among consortium members.MethodsTo achieve these goals, it was determined that a smaller group of stakeholders besides governing officials is needed to provide guidance for regional data sharing and use. The etiquette group was established in the first quarter of 2018 and it included four consortium representatives from the 6/5 south region of Texas. Their first meeting tackled issues relating to data sharing.ResultsThe following products emerged from the activities of the etiquette group within 3 months of its existence:● Publication/presentation guidance/policy to avoid duplication of efforts and misrepresentation of jurisdiction.● Procedure for alert responses●. Instructions for within-systems management of alerts;●. Instructions for events/times of interest (e.g., political convention, Olympics);● Instructions of syndromes of interest/syndrome-specific policies;● Instructions for changing the syndrome definition;● Notification procedures for identification of a single case of reportable disease/important free text element within data.ConclusionsCross jurisdictional workgroups can influence rapid investigations of disease, protect patient health information and promote privacy and data security and confidentiality by establishing set rules/guidelines for data exchange. All 13-counties in the region rely on these guidelines as a standard for responsibly accessing, using and sharing data in the Texas Southeast ESSENCE system.Lessons Learned:● As the etiquette group continues to evolve, there is need for more resources to help foster data use and sharing among jurisdictional partners.● Partner engagement is limited due to ongoing process of configuring the new system ESSENCE.● Since disease has no boundaries, allocation of jurisdictional responsibilities for responding to alerts should be operationalized● Continuous training is essential to ensure all system users adhere to the protocols in place for meaningful data use and data sharin

Susceptibility Profile of Drug-Resistant Streptococcus pneumoniae Based on ELR

The automated retrieval of antimicrobial susceptibility information via ELR expands public health surveillance without expending additional resources. This study presents the antimicrobial susceptibilities of drug-resistant Streptococcus pneumoniae in a local safety net hospital cohort and compares them with the susceptibilities found by the Centers for Disease Control and Prevention's Active Bacterial Core surveillance (ABCs) program. Demographic characteristics and vaccine history of the patients are also reported. The study found one large difference in percentage susceptibility for one antimicrobial drug (penicillin), suggesting a need to develop regional antimicrobial profiles to better inform clinical decisions

Susceptibility Profile of Drug-Resistant Streptococcus pneumoniae Based on ELR

The automated retrieval of antimicrobial susceptibility information via ELR expands public health surveillance without expending additional resources. This study presents the antimicrobial susceptibilities of drug-resistant Streptococcus pneumoniae in a local safety net hospital cohort and compares them with the susceptibilities found by the Centers for Disease Control and Prevention's Active Bacterial Core surveillance (ABCs) program. Demographic characteristics and vaccine history of the patients are also reported. The study found one large difference in percentage susceptibility for one antimicrobial drug (penicillin), suggesting a need to develop regional antimicrobial profiles to better inform clinical decisions

Exploring Drug Overdose Mortality Data in Harris County, Texas

ObjectiveIn this session, we will explore the results of a descriptive analysis of all drug overdose mortality data collected by the Harris County Medical Examiner's Office and how that data can be used to inform public health action.IntroductionDrug overdose mortality is a growing problem in the United States. In 2017 alone over 72,000 deaths were attributed to drug overdose, most of which were caused by fentanyl and fentanyl analogs (synthetic opioids)1. While nearly every community has seen an increase in drug overdose, there is considerable variation in the degree of increase in specific communities. The Harris County community, which includes the City of Houston, has not seen the massive spikes observed in some communities, such as West Virginia, Kentucky, and Ohio. However, the situation in Harris County is complicated in mortality and drug use. From 2010 - 2016 Harris County has seen a fairly stable overdose-related mortality count, ranging from 450 - 618 deaths per year. Of concern, the last two years, 2015-2016, suggest a sharp increase has occurred. Another complexity is that Harris County drug related deaths seem to be largely from polysubstance abuse. Deaths attributed to cocaine, methamphetamine, and benzodiazipine all have risen in the past few years. Deaths associated with methamphetamine have risen from approximately 20 per year in 2010 - 2012 to 119 in 2016. This 6-fold increase is alarming and suggests a large-scale public health response is needed.MethodsData were collected by the Harris County Institute of Forensic Sciences (IFS), which is part of the Harris County Medical Examiner's Office. IFS is the agency responsible for collecting and analyzing human tissue of the deceased for toxicological information about the manner and cause of death. IFS is able to test for the presence of multiple substances, including opioids, benzodiazepines, methamphetamines, cocaine, ethanol, and many others.These data were cleaned and labeled for the presence of opioids, cocaine, benzodiazepine, Z-drug (novel drug), amphetamines, ethanol, and carisoprodol. Explorative descriptive analyses were then completed in R (version 3.4) to identify trends. An RShiny app was created to further explore the data by allowing for rapid filtering and/or subsetting based on various demographic characteristics (e.g., age, sex, race).ResultsWe found that Harris County is experiencing a modest upward trend of drug related overdoses, with 529 observed in 2010 and 618 in 2016. We also found that the increase was not uniform across all classified drugs: amphetamines, cocaine, and ethanol all saw increases. Deaths involving amphetamine increased substantially from 21 in 2010 to 119 in 2016 (Figure 1). Deaths involving cocaine saw the next sharpest increase with 144 in 2010 and 237 in 2016. Deaths associated with opioids remained fairly constant, with 291 deaths in 2010 and 271 deaths in 2016.Differences in mortality across race and sex groups were also observed. The proportion of amphetamine deaths among whites jumped sharply, while the proportion of opioid and benzodiazepine deaths among whites decreased in recent years. The proportion of amphetamine and cocaine deaths among men rose more sharply than with women in the past three years, whereas for opioids, the proportion of women dying has dropped.ConclusionsIt is undeniable that the opioid epidemic is a true public health emergency for the nation. New surveillance tools are needed to better understand the impact and nature of this threat. Additionally, as we have found in Harris County, the threat may be polysubstance in nature.Our report offers two important insights: 1) that mortality data is a useful and actionable surveillance resource in understanding the problem of substance abuse; and 2) public health needs to look at substance abuse from a holistic and comprehensive perspective. Keeping the purview limited to opioids alone may create significant blind spots to the public health threat facing us.References1. National Institute of Health. (2018) Overdose Death Rates. Retreived from https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rate

Analysis of Frankino 2005 Data R Markdown

R Markdown script of the analysis of the Frankino 2005 data, as described in Frankino et al 2019

Analysis of Frankino 2005 Data PDF

PDF generated by the R Markdown script analyzing the Frankino 2005 dat