Issue 25 - With Frequent High Profile Events - Syndromic Surveillance in Full Swing

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With Frequent High Profile Events - Syndromic Surveillance in Full Swing
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At this writing, the Democratic National Convention is in its 4-day run in Boston. The Olympics will begin in about three weeks, followed by the Republican National Convention August 30th in New York City. All three high profile events will be marked with expansive TV coverage, lots of people, and plenty of attention to the event. Just the recipe for those wanting to create terror and chaos.

However, we can be thankful that in the background, syndromic surveillance teams will be quietly watching for disease trends in local emergency rooms, clinics, EMS runs, and pharmaceutical sales. And, instead of labor intensive paper systems which characterized drop-in syndromic surveillance in the past, most cities have opted for sophisticated, computer-based warning systems that could identify bioterrorist attacks or other outbreaks quickly. (1)

The Boston Public Health Commission began a citywide syndromic surveillance system June 1, collecting information from all hospital emergency rooms in the city. This is an enhancement from a previous system, which only tracked information from a few city emergency rooms. "The computer will tag the aberrations. If there’s a spike in volume, we’ll look deeper into it." (1) Information gathered since June 1 will be used as baseline data for the surveillance analysis during the Democratic convention.

In the meantime, New York City’s Department of Health and Mental Hygiene has a very sophisticated syndromic surveillance system already in place. Greatly enhanced since 2001, syndromic surveillance in NYC involves tracking emergency room visits, drug store sales, and absentee records, as well as other data (1).

According to Dr Farzad Mostashari, assistant commissioner for the city’s Bureau of Epidemiology Services, they plan to "increase the sensitivity of computer programs during the Republican National Convention, in order to catch outbreaks at lower thresholds, and tighten the focus of data collected immediately around the convention site". (1)

Finally, we have been inundated with reports in the press regarding problems and lack of adequate planning in Greece for the upcoming Olympic Games. However, the syndromic surveillance community in Greece can certainly not be faulted for a lack of planning. In October 2002, Urania Dafni et al presented the results of their pilot study for the syndromic surveillance program planned for the 2004 Summer Olympic Games. Using the Salt Lake City 2002 Olympic syndromic surveillance system as a template, they created a surveillance system using 14 hospital emergency rooms in the greater Athens area. Tracking 12 syndromes, the Greek organization manually entered data faxed from onsite into Excel and SAS, creating reports daily. (2, 3)

In 2003, at the National Syndromic Surveillance Conference in NYC, the Greeks again reported on their system, displaying charts of the number of cases for each syndrome and describing a novel statistical method to identify outbreaks called "modified pulsar analysis". This method was originally developed to model episodic hormone secretion, but seems to work very well at identifying disease clusters in simulated data sets. Expected to be fully operational before the Olympics, the Greek system will institute an investigation if there is a single unusual event (e.g., 1 case of anthrax) or a cluster of events exceeding threshold levels. (4)

We all hope that no intentional outbreaks occur at these highly visible events. But it is reassuring to know that if a disease outbreak or bioterrorist strike occurs, syndromic surveillance is poised to capture the event and alert public health and health care professionals in time to save lives.

(1) Lipowicz, Alice. Surveillance systems will track Disease Outbreaks at Conventions. CQ Homeland Security & Technology. June 7, 2004. Accessed at www.homelandsecurity.osu/edu/focusareas/sensors.htm.

(2) Dafni, Urania et al. Planning Syndromic Surveillance for the Athens 2004 Olympic Games: A Pilot Study. Poster Presentation for the 2002 National Syndromic Surveillance Conference. Accessed at:
www.syndromic.org/syndromicconference/2002/posterpdf/dafni_handout.jpg

(3) Dafni, Urinia et al. Planning Syndromic Surveillance for the Athens 2004 Olympic Games: a Pilot Study. Poster Abstract for the 2002 National Syndromic Surveillance Conference. Accessed at:
http://www.syndromic.org/syndromicconference/2002/Supplementpdf/Abstracts_SectionII.pdf

(4) Dafni Urania et al. An algorithm for a statistical detection of peaks: The Syndromic Surveillance System for the Athens 2004 Olympics. Accessed at:
www.syndromic.org/ppt/con2-UD-6a-ppt

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