Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 Jan;29(1):70-4.
doi: 10.1016/j.ajem.2009.09.009. Epub 2010 Mar 25.

ED syndromic surveillance for novel H1N1 spring 2009

Marc A Bellazzini  1 , Kyle D Minor
Affiliations

ED syndromic surveillance for novel H1N1 spring 2009

Marc A Bellazzini et al. Am J Emerg Med. 2011 Jan.

Abstract

Purpose: The aim of this study is to demonstrate the use of emergency department (ED) syndromic surveillance in the setting of a novel and unexpected H1N1 influenza outbreak.

Basic procedures: Data collection from ED electronic medical records was used to track initial chief complaint and discharge International Classification of Diseases, Ninth Revision, codes related to influenza-like illness (ILI). An alert threshold was generated using cumulative sum sequential analysis technique. The data were retrospectively analyzed to identify alerts that correlated with novel influenza H1N1 illness.

Main findings: Our system alerted for ILI earlier than both the official national Centers for Disease Control and Prevention (CDC) press release for novel H1N1 and the first laboratory confirmed case in our county.

Principal conclusions: Emergency department syndromic surveillance can be used to detect unexpected ILI before laboratory confirmation and serve as an adjunct to traditional laboratory-guided public health alerts. Early identification may allow for more efficient laboratory testing and early implementation of respiratory isolation precautions.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Example of calculation of Alert Threshold using a modified CuSUM technique.
Figure 2
Figure 2. ICD-9 Data Stream for 2008-2009 Influenza Season
This figure shows the daily counts, the CUSUM line (______) and the CUSUM + 2.5 standard deviation alerting threshold line (….) . Exceeded alert threshold dates are depicted in red. First alert for H1N1 season occurred on April 18th, the second alert occurred on April 29th. The CDC press release for H1N1 cases in the United States occurred on April 23rd (PR), and the first laboratory confirmed case occurred on May 6th. (CD)”
Figure 3
Figure 3. Chief Complaint Data Stream for 2008-2009 Influenza Season
This figure shows the daily counts of ILI chief complaint, the CUSUM line (______) and the CUSUM + 2.5 standard deviation alerting threshold line (….) . Exceeded alert threshold dates are depicted in red. The only alert for H1N1 season occurred on April 29th. The CDC press release for H1N1 cases in the United States occurred on April 23rd (PR), and the first laboratory confirmed case occurred on May 6th (CD).
Figure 4
Figure 4
ILI activity for typical influenza season 2007-2008
See this image and copyright information in PMC

References

    1. Cooper DL, Verlander NQ, Smith GE, Charlett A, Gerard E, Willocks L, O’Brien S. Can syndromic surveillance data detect local outbreaks of communicable disease? A model using a historical cryptosporidiosis outbreak. Epidemiol Infect. 2006 Feb;134(1):13–20. - PMC - PubMed
    1. Lemay R, Mawudeku A, Shi Y, Ruben M, Achonu C. Syndromic surveillance for influenzalike illness. Biosecur Bioterror. 2008 Jun;6(2):161–70. - PubMed
    1. Marx MA, Rodriguez CV, Greenko J, Das D, Heffernan R, Karpati AM, Mostashari F, Balter S, Layton M, Weiss D. Diarrheal illness detected through syndromic surveillance after a massive power outage: New York City, August 2003. Am J Public Health. 2006 Mar;96(3):547–553. - PMC - PubMed
    1. Das D, Metzger K, Heffernan R, Balter S, Weiss D, Mostashari F. Monitoring over-the-counter medication sales for early detection of disease outbreaks--New York City. MMWR Morb Mortal Wkly Rep. 2005 Aug 26;54(Suppl):41–46. - PubMed
    1. Besculides M, Heffernan R, Mostashari F, Weiss D. Evaluation of school absenteeism data for early outbreak detection, New York City. BMC Public Health. 2005:5105. - PMC - PubMed

Publication types

MeSH terms