Peat Bog Wildfire Smoke Exposure in Rural North Carolina Is Associated with Cardiopulmonary Emergency Department Visits Assessed through Syndromic Surveillance

Background: In June 2008, burning peat deposits produced haze and air pollution far in excess of National Ambient Air Quality Standards, encroaching on rural communities of eastern North Carolina. Although the association of mortality and morbidity with exposure to urban air pollution is well established, the health effects associated with exposure to wildfire emissions are less well understood. Objective: We investigated the effects of exposure on cardiorespiratory outcomes in the population affected by the fire. Methods: We performed a population-based study using emergency department (ED) visits reported through the syndromic surveillance program NC DETECT (North Carolina Disease Event Tracking and Epidemiologic Collection Tool). We used aerosol optical depth measured by a satellite to determine a high-exposure window and distinguish counties most impacted by the dense smoke plume from surrounding referent counties. Poisson log-linear regression with a 5-day distributed lag was used to estimate changes in the cumulative relative risk (RR). Results: In the exposed counties, significant increases in cumulative RR for asthma [1.65 (95% confidence interval, 1.25–2.1)], chronic obstructive pulmonary disease [1.73 (1.06–2.83)], and pneumonia and acute bronchitis [1.59 (1.07–2.34)] were observed. ED visits associated with cardiopulmonary symptoms [1.23 (1.06–1.43)] and heart failure [1.37 (1.01–1.85)] were also significantly increased. Conclusions: Satellite data and syndromic surveillance were combined to assess the health impacts of wildfire smoke in rural counties with sparse air-quality monitoring. This is the first study to demonstrate both respiratory and cardiac effects after brief exposure to peat wildfire smoke

Enhanced Surveillance during the Democratic National Convention, Charlotte, NC

North Carolina's statewide syndromic surveillance system, NC DETECT, was enhanced to provide streamlined surveillance during the Democratic National Convention. New dashboards were created that allowed epidemiologists to monitor ED visits and calls to the poison center in the Charlotte area, the greater Cities Readiness Initiative region and the entire state for infectious disease signs and symptoms, injuries and any mention of bioterrorism agents

Enhanced Surveillance during the Democratic National Convention, Charlotte, NC

OBJECTIVE: To describe how the existing state syndromic surveillance system (NC DETECT) was enhanced to facilitate surveillance conducted at the Democratic National Convention in Charlotte, North Carolina from August 31, 2012 to September 10, 2012. INTRODUCTION: North Carolina hosted the 2012 Democratic National Convention, September 3–6, 2012. The NC Epidemiology and Surveillance Team was created to facilitate enhanced surveillance for injuries and illnesses, early detection of outbreaks during the DNC, assist local public health with epidemiologic investigations and response, and produce daily surveillance reports for internal and external stakeholders. Surveillane data were collected from several data sources, including North Carolina Electronic Disease Surveillance System (NC EDSS), triage stations, and the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT). NC DETECT was created by the North Carolina Division of Public Health (NC DPH) in 2004 in collaboration with the Carolina Center for Health Informatics (CCHI) in the UNC Department of Emergency Medicine to address the need for early event detection and timely public health surveillance in North Carolina using a variety of secondary data sources. The data from emergency departments, the Carolinas Poison Center, the Pre-hospital Medical Information System (PreMIS) and selected Urgent Care Centers were available for monitoring by authorized users during the DNC. METHODS: Within NC DETECT, new dashboards were created that allowed epidemiologists to monitor ED visits and calls to the poison center in the Charlotte area, the greater Cities Readiness Initiative region and the entire state for infectious disease signs and symptoms, injuries and any mention of bioterrorism agents. The dashboards also included a section to view user comments on the information presented in NC DETECT. Data processing changes were also made to improve the timeliness of the EMS data received from PreMIS. RESULTS: The DNC dashboards added to NC DETECT streamlined the workflow by placing all syndromes and annotations of interest in one place, with the date ranges and locations already pre-selected. Graphs in the dashboards could be easily copied and pasted into situation reports. The prompt development of these user-friendly tools provided effective surveillance for this mass gathering and ensured timely control measures, if necessary. CONCLUSIONS: Syndromic surveillance systems can be enhanced to provide detailed, specific surveillance during mass gathering events. Elements that facilitate this enhancement include strong communication between skilled users and the informatics team, in order to minimize the burden placed on the surveillance team system users, data sources and system developers during the event. The visualizations developed as part of these new dashboards will be leveraged to provide additional tools to other NC DETECT user groups, including hospital-based public health epidemiologists and local health department users. [Figure: see text

Poison Control Center Data in the NC DETECT Syndromic Surveillance System

ObjectiveTo describe Carolinas Poison Control Center (CPC) calls datacollected in the NC DETECT syndromic surveillance system.IntroductionCPC provides the 24/7/365 poison hotline for the entire state ofNorth Carolina and currently handles approximately 80,000 callsper year. CPC consultation services that assist callers with poisonexposure, diagnosis, optimal patient management, therapy, andpatient disposition guidance remain indispensable to the public andhealth care providers. Poison control center data have been used foryears in syndromic surveillance practice as a reliable data source forearly event detection. This information has been useful for a varietyof public health issues, including environmental exposures, foodbornediseases, overdoses, medication errors, drug identification, drug abusetrends and other information needs. The North Carolina Departmentof Health and Human Services started formal integration of CPCinformation into surveillance activities in 2004. CPC call data areuploaded in real time (hourly), 24/7/365, to the NC DETECT statedatabase.MethodsCPC calls collected by NC DETECT from 2009-2015 wereanalyzed in this descriptive study. Counts of CPC calls wereexamined by year to assess total volume and changes over time, bymonth to assess seasonality, by geographic location, and call sitefacility and call originator. CPC calls were also categorized by type ofcall – exposure calls versus information calls – in order to determinewhy people call CPC and to assess if any trends exist amongst thesecategories.ResultsThe majority of CPC calls originate from the caller’s own residence(53.40%). The age groups most represented are 0-1 years old,2-4 years old, and 25-44 years old. Calls to CPC were for male andfemale patients in approximately equal numbers. The region of NCthat has the highest number of calls, by a fairly wide margin, is theCharlotte Metro region. In 2009, the total number of CPC calls wasover 120,000. This number decreased monotonically every yearfollowing, with the total in 2015 being 80,000. This is a 1/3 reductionin the total number of calls over 7 years. When the calls were analyzedby type of call, an interesting trend emerged. The total number ofexposure calls remained relatively constant over the time period,ranging from 64,000 to 68,000 per year. However, the total number ofinformation calls decreased each year going from just over 40,000 toonly about 5,000. When examined by month to assess seasonality, thedata show an increase in the number of calls beginning in Februaryand peaking in May, and then a steady and slow decline throughoutthe rest of the year.ConclusionsOur study shows that CPC consultations from callers with exposureshave remained stable over time. However, in the absence of exposure,fewer people call CPC for information on various substances. Drugidentification calls saw a decrease each year during the study timeperiod. In 2009 there were 34,495 drug identification calls and in2015 there were 5,722. This dramatic decrease in information callsis most likely due to the increased use of the internet and searchengines. Because people have more access to the internet, especiallyvia mobile devices, they may not feel the need to call CPC to obtaininformation

Poison Control Center Data in the NC DETECT Syndromic Surveillance System

ObjectiveTo describe Carolinas Poison Control Center (CPC) calls datacollected in the NC DETECT syndromic surveillance system.IntroductionCPC provides the 24/7/365 poison hotline for the entire state ofNorth Carolina and currently handles approximately 80,000 callsper year. CPC consultation services that assist callers with poisonexposure, diagnosis, optimal patient management, therapy, andpatient disposition guidance remain indispensable to the public andhealth care providers. Poison control center data have been used foryears in syndromic surveillance practice as a reliable data source forearly event detection. This information has been useful for a varietyof public health issues, including environmental exposures, foodbornediseases, overdoses, medication errors, drug identification, drug abusetrends and other information needs. The North Carolina Departmentof Health and Human Services started formal integration of CPCinformation into surveillance activities in 2004. CPC call data areuploaded in real time (hourly), 24/7/365, to the NC DETECT statedatabase.MethodsCPC calls collected by NC DETECT from 2009-2015 wereanalyzed in this descriptive study. Counts of CPC calls wereexamined by year to assess total volume and changes over time, bymonth to assess seasonality, by geographic location, and call sitefacility and call originator. CPC calls were also categorized by type ofcall – exposure calls versus information calls – in order to determinewhy people call CPC and to assess if any trends exist amongst thesecategories.ResultsThe majority of CPC calls originate from the caller’s own residence(53.40%). The age groups most represented are 0-1 years old,2-4 years old, and 25-44 years old. Calls to CPC were for male andfemale patients in approximately equal numbers. The region of NCthat has the highest number of calls, by a fairly wide margin, is theCharlotte Metro region. In 2009, the total number of CPC calls wasover 120,000. This number decreased monotonically every yearfollowing, with the total in 2015 being 80,000. This is a 1/3 reductionin the total number of calls over 7 years. When the calls were analyzedby type of call, an interesting trend emerged. The total number ofexposure calls remained relatively constant over the time period,ranging from 64,000 to 68,000 per year. However, the total number ofinformation calls decreased each year going from just over 40,000 toonly about 5,000. When examined by month to assess seasonality, thedata show an increase in the number of calls beginning in Februaryand peaking in May, and then a steady and slow decline throughoutthe rest of the year.ConclusionsOur study shows that CPC consultations from callers with exposureshave remained stable over time. However, in the absence of exposure,fewer people call CPC for information on various substances. Drugidentification calls saw a decrease each year during the study timeperiod. In 2009 there were 34,495 drug identification calls and in2015 there were 5,722. This dramatic decrease in information callsis most likely due to the increased use of the internet and searchengines. Because people have more access to the internet, especiallyvia mobile devices, they may not feel the need to call CPC to obtaininformation

Triage Notes in Syndromic Surveillance – A Double Edged Sword

The advent of Meaningful Use has allowed for the expansion of data collected at the hospital level and received by public health for syndromic surveillance. The triage note, a free text expansion on the chief complaint, is one of the many variables that are becoming commonplace in syndromic surveillance data feeds. This roundtable will provide a forum for the ISDS community to discuss the use of emergency department triage notes in syndromic surveillance. It will be an opportunity to discuss both the benefits of having this variable included in syndromic surveillance data feeds, as well as the drawbacks and challenges associated with working with such a detailed data field

Identifying Emerging Novel Outbreaks In Textual Emergency Department Data

We apply a novel semantic scan statistic approach to solve a problem posed by the NC DETECT team, North Carolina Division of Public Health (NC DPH) and UNC Department of Emergency Medicine Carolina Center for Health Informatics, and facilitated by the ISDS Technical Conventions Committee. This use case identifies a need for methodology that detects emerging, potentially novel outbreaks in free-text emergency department (ED) chief complaint data. Our semantic scan approach successfully addresses this problem, eliminates the need for classifying cases into pre-defined syndromes and identifies emerging clusters that public health officials could not have predicted in advance

Triage Notes in Syndromic Surveillance – A Double Edged Sword

The advent of Meaningful Use has allowed for the expansion of data collected at the hospital level and received by public health for syndromic surveillance. The triage note, a free text expansion on the chief complaint, is one of the many variables that are becoming commonplace in syndromic surveillance data feeds. This roundtable will provide a forum for the ISDS community to discuss the use of emergency department triage notes in syndromic surveillance. It will be an opportunity to discuss both the benefits of having this variable included in syndromic surveillance data feeds, as well as the drawbacks and challenges associated with working with such a detailed data field

Using Syndromic Surveillance Data to Monitor Endocarditis and Sepsis among Drug Users

ObjectiveTo describe how the state syndromic surveillance system(NC DETECT) was used to initiate near real time surveillance forendocarditis, sepsis and skin infection among drug users.IntroductionRecreational drug use is a major problem in the United States andaround the world. Specifically, drug abuse results in heavy use ofemergency department (ED) services, and is a high financial burdento society and to the hospitals due to chronic ill health and multipleinjection drug use complications. Intravenous drug users are at highrisk of developing sepsis and endocarditis due to the use of a dirty orinfected needle that is either shared with someone else or re-used. Itcan also occur when a drug user repeatedly injects into an inflamedand infected site or due to the poor overall health of an injection druguser. The average cost of hospitalization for aortic valve replacementin USA is about $165,000, and in order for the valve replacement tobe successful, patients must abstain from using drugs.MethodsWe examined temporal trends of drug-related visits to hospitalEDs, as well as drug-related related ED admissions complicated withendocarditis, bacteremia and sepsis.ResultsThe trends in Endocarditis/Sepsis and drug-related relatedadmissions appear to echo overdose related ED admissions increase.Patients ED return visits and hospitalizations for the same problem arealso growing compare to the previous years. We will discuss the NCDETECT case definition used to monitor drug overdose/dependenceand infection, case definition transition from ICD-9 to ICD-10 codes,and will share surveillance analysis results.ConclusionsNC DETECT’s system flexibility has been important in rapidlyestablishing surveillance of infections among drug users. Near realtime analysis on hospital, county and state levels can be performedusing NC DETECT system reports to provide state officials, hospitalsand LHDs with situational awareness. Limitations: Syndromicsurveillance ED data contains less accurate information about thediagnosis codes, procedures, length of stay, and severity comparingto the hospital discharge data