Issue 13 - July 2003 : INFECTION CONTROL CONVENTION HIGHLIGHTS SYNDROMIC SURVEILLANCE IN SAN ANTONIO

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INFECTION CONTROL CONVENTION HIGHLIGHTS SYNDROMIC SURVEILLANCE IN SAN ANTONIO
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At the recent Association for Professionals in Infection Control and Epidemiology, Inc. (APIC) annual conference in San Antonio, the Chief Epidemiologist for the City of San Antonio, Roger Sanchez, took part in a panel discussion on the topic “Bioterrorism: Pieces of the Puzzle: San Antonio’s Approach to Bioterrorism”. He described the changes San Antonio had experienced after 9-11, including the addition of syndromic surveillance to their bioterrorism prevention arsenal. (1)

One of the things 9-11 highlighted was “a lack of funding for public health.” The response was a 1.8 million dollar grant to San Antonio last year, “to increase our public health infrastructure.” This grant allowed them to purchase a number of things, including software for syndromic surveillance. Mr. Sanchez stated that he looked at a number of software systems over the past 18 months, but ultimately decided on RedBat® by ICPA, Inc. Austin, Texas because it offered a professional product and support at an affordable price.

He began using the system in March 2003, and already has over 60,000 records in his database dating from January 1, 2003. Ultimately, 16 emergency rooms from all over San Antonio will participate. In many hospitals, Infection Control Practitioners are the point of contact, and they “play a big role in this process, and are becoming very computer literate.”

He displayed rate graphs created with the system for different syndromes. From January 1 to June 5, 2003, he identified an increase in probable influenza in the first part of the year, and an unknown respiratory syndrome later, possibly due to asthma.

He also noted increases in visits for nausea/vomiting beginning at the end of May. During that same time period the food inspectors were noticing increased reports of food poisoning. Also, an elementary school had 71 absences (children and staff) for nausea and vomiting. However, an extensive investigation of that school found no common source. He attributes the increase to “just a general community wide increase in viral gastroenteritis” rather than an outbreak due to a preventable cause.

Mr. Sanchez displayed a graph on GI illnesses since January for children, and then showed how it differed from a GI graph for adults during the same time period. Looking at infectious syndromes stratified by age “has more relevance than one would think”. The pediatric graph (children under age 3) appears to be a good gauge of rotoviral activity.

While he believes that he needs more experience to appreciate all the benefits of syndromic surveillance, the software performs as it was intended. It successfully “alerts someone when there is an aberration of some sort in the numbers of individuals showing up at a number of different emergency rooms.” Mr. Sanchez argues that syndromic surveillance is not just good for bioterrorism, but should be used for other routine surveillance tasks, like monitoring emergency room visits for injuries or asthma. Like other skills, “if you don’t use it, you’re going to lose it.”

In addition to syndromic surveillance, Mr. Sanchez also performs school absenteeism surveillance. He monitors 143 schools with children of all ages, and displayed graphs illustrating school absenteeism by percent of total enrollment. There was an increase in absenteeism during the respiratory season which ended in January.

Finally, to the question “What is our [health department] piece of the bioterrorism puzzle” he concluded that “We are much more 24/7 capable in our community. We have increased our expertise and tightened up our protocols. We have greatly augmented our surveillance network throughout out community, by establishing a much better network with our hospitals -- and this included the infection control practitioners.”

(1) APIC Convention Symposium. Bioterrorism: Pieces of the Puzzle: San Antonio’s Approach to Bioterrorism Planning and the Role of the ICP. Presented June 10, 2003. Participants: Eric Epley, Roger Sanchez, Dennis Perrotta, Rasa Silenas, Nancy Bjerke.

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