Issue 17 - November 2003: THE 2nd ANNUAL SYNDROMIC SURVEILLANCE CONFERENCE

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THE 2nd ANNUAL SYNDROMIC SURVEILLANCE CONFERENCE
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On October 20-24, 2003 the New York Academy of Medicine, the NYC Department of Health and the CDC co-sponsored the 2nd Annual Syndromic Surveillance Conference in New York City. The challenge of this meeting was to match the incredibly successful initial conference, where the emerging science of Syndromic Surveillance was unveiled for the first time. While it is hard to match the enthusiasm of something brand new, the second conference proved that we are still on the cutting edge of something incredibly exciting.

An added bonus this year was the pre-conference workshop held on Oct 20-22nd, which was limited to personnel from state and local public health departments. In this workshop the New York City Dept of Health and Mental Hygiene conducted a hands-on instruction of how they built their syndromic surveillance system. Since it is built on SAS™, participants were required to bring a laptop with SAS™ v 7 or higher installed. Topics included: negotiating with data providers, data elements used in syndromic surveillance, options for transmission and processing, syndrome coding, and data warehousing. The participants practiced using SAS™ for data processing and archiving, and using the SaTScan™ software for data analysis. Finally, they discussed how to investigate signals and national resources for syndromic surveillance. (1)

The considerable effort and expense required to set up a syndromic surveillance system from scratch (not to mention the need for SAS programming skills) are considerable roadblocks. However, the conference instructors should be commended for their willingness to share their expertise and experience. The good news is that Local Health Departments don’t have to be trailblazers in this endeavor, as good syndromic surveillance software can now be obtained quickly and inexpensively.

The Annual Syndromic Surveillance Conference itself was held October 23-24 and was patterned largely after the 2002 conference. However, this year there was little argument about the definition of “syndromic surveillance”. In fact, the subtitle of the conference “A Focus on the Use of Non-Diagnostic Data for Real-Time Outbreak Detection” reflects the consensus that “syndromic surveillance” means monitoring pre-diagnostic information using existing data collected for other purposes and analyzed in real or near real-time. (2) Note that this definition excludes systems that track ICD-9 codes and/or laboratory results (both are “diagnostic”).

Interesting topics in this two day conference included: examples of outbreaks large and small detected through syndromic surveillance; performance evaluations of different syndrome groupings; challenges faced by local and state health departments in implementing syndromic surveillance; dealing with data providers; confidentiality issues and how the law applies to syndromic surveillance; how to investigate signals, and outbreak response. (3)

Although many speakers agreed that the most valuable data came from hospital emergency visits, there was no consensus about which syndromes to monitor, which statistical models to use, and which “flags” to investigate. It was very clear to the audience that this science is in its infancy, and will take many years to mature.

Overall, however, the conference was a success. Although it raised more questions than it answered, participants were still enthusiastic about the future of syndromic surveillance for outbreak detection, disease monitoring, and improving communication links between public health and healthcare providers.

(1) www.epimonitor.net/epimonday/nyam_09_01.htm
(2) http://www.cdc.gov/epo/dphsi/syndromic.htm
(3) http://www.nyam.org/events/syndromicconference/program_agenda.shtml

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