Staffing RODS in OhioStaffing RODS in Ohio

February 23February 23rdrd, 2006, 2006Biosurveillance Information Exchange Working GroupBiosurveillance Information Exchange Working Group

Rutgers UniversityRutgers UniversityPiscataway, NJPiscataway, NJ

Loren Shaffer, MPHLoren.Shaffer@odh.ohio.gov

Early Event Surveillance Supervisor

Our Current SystemsOur Current Systems

• Real-time Outbreak and Disease Surveillance (RODS) System

• BioSense• Influenza-like Illness Sentinel Providers• School Absenteeism• Wildlife Disease Surveillance• Ohio Disease Reporting System• Early Aberration Reporting System (EARS)

RODSRODS• Developed at the University of Pittsburgh• Utilizes a hospital’s existing HL-7 socket to receive real-time data• Interprets free-text chief complaint from emergency department

registration database and groups into one of seven prodromes• Collects information from retailers about sales of over-the-

counter medications• Provides immediate analysis for trends and anomalies

suggestive of disease outbreaks• Secure web access by users

HIPAAHIPAA

• Export of data for public health surveillance is permitted (45 CFR 164.512)

• Prior written authorization of individual is not required (45 CFR 164.512)

End Users of RODS in Ohio

• Total = 174– State Health Department = 6– Local Health Department = 87

• 88 of 135 LHDs represented

– Hospital = 77– Other = 4

RODS Alerts

• February 2004 to February 2006– 310 unique alerts received

• Seasonal Elevation – 40%• Outbreaks – 22%• Data Errors – 9%• No Cause Identified – 28%

– 53% handled at State level– 47% forwarded to local epidemiologist

RODS Alerts and Reported Outbreaks in Ohio

2/1/2004 - 2/1/2006

Date of RODS Alert

Syndrome County Outbreak Cause Number IllDate Reported to

ODH

12/24/2004 Respiratory Statewide CO Poisoning ~50 not reported

1/11/2005 Gastrointestinal Franklin Norovirus 7 1/24/2005

1/11/2005 Gastrointestinal Franklin Norovirus 3 2/16/2005

1/30/2005 Gastrointestinal Mahoning Norovirus 5 2/9/2005

3/3/2005 Gastrointestinal Mahoning C perfringens 4 3/14/2005

10/26/2005 Gastrointestinal Preble Norovirus ~300 11/4/2005

11/23/2005 Rash Jefferson Scabies 5 not reported

12/27/2005 Gastrointestinal Montgomery Campylobacter 3 1/30/2006

8/3/2005 8/4/2005 8/5/2005

Gastrointestinal Constitutional Gastrointestinal

Hamilton Cryptosporidiosis ~750 8/22/2005

1/9/2006 Constitutional Scioto Scromboid Poisoning 3 1/30/2006

1/18/2006 Respiratory Erie Influenza-like Illness 24 not reported

*Information about the number ill and date reported was obtained from the Ohio Disease Reporting System (ODRS)

What are we doing with RODS?What are we doing with RODS?• Monitoring for patterns suggestive of an

infectious disease outbreak• Influenza surveillance study & efforts• Retrospective outbreak study (improved

specificity)• Adaptation to animal-based sources for

emerging infectious disease surveillance• Real-time clinical data analysis• Environmental surveillance• Specialized investigations

InfluenzaInfluenza

InfluenzaInfluenza

Summary of Correlation Analysis 2003/2004 and 2004/2005 Influenza Seasons

Franklin Montgomery Summit Average

DataLead

(weeks)Correlation Coefficient

Lead (weeks)

Correlation Coefficient

Lead (weeks)

Correlation Coefficient

Lead (weeks)

Correlation Coefficient

Thermometer 4 0.5908 4 0.6254 3 0.5226 3.67 0.5796Cough & Cold 4 0.5592 5 0.5728 3 0.4522 4.00 0.5281Pediatric Cough Syrup 4 0.5079 4 0.5487 3 0.4591 3.67 0.5052Adult Cough Syrup 4 0.2133 4 0.2938 3 0.3042 3.67 0.2704Pediatric Cold Relief 4 0.5730 4 0.5236 4 0.4541 4.00 0.5169Adult Cold Relief 4 0.5985 4 0.5875 4 0.4783 4.00 0.5548Pediatric Antifever 5 0.5524 5 0.4626 3 0.3788 4.33 0.4646Adult Antifever 5 0.3224 1 0.3844 5 0.1901 3.67 0.2990VA Clinic Visits 7 0.3081DoD Clinic Visits 7 0.3159Class B -1 0.4470 4 0.5107 0 0.2594 1.00 0.4057Respiratory ED Visits 4 0.5544 5* 0.5227 4.00 0.5386Constitutional ED Visits 4 0.5133 4* 0.4603 4.00 0.4868

ILI Sentinel Providers 5 0.2311 5 0.5591 3 0.57054.33 (4 w /o

Franklin)

0.4536 (0.5648 w /o

Franklin)

School Absences 10 0.2852 4* 0.4540 5 0.3965 7.50 0.3786Laboratory Analysis 5 0.5943 3 0.5966 4.00 0.5955* = Data From 1 Influenza Season

P(↑Consitutional|Outbreak N)= xc

P(↑Botulinic|Outbreak N)= xb

P(↑Respiratory|Outbreak N)= xr

P(↑GI|Outbreak N) = xg

P(↑Hemorrhagic|Outbreak N)= xh

P(↑Neurologic|Outbreak N)= xn

P(↑Rash|Outbreak N)= xra

P(↑Thermometer|Outbreak N)= xt

P(↑Cold Relief|Outbreak N)= xcr

P(↑Lozenges|Outbreak N)= xl

P(↑Chest Rubs|Outbreak N) = xchr

P(↑Bronchial Remedies|Outbreak N)= xbr

P(↑Antifever|Outbreak N)= xa

P(↑Other Categories|Outbreak N)= x

OTC SalesED Registrations

Known Outbreak

Zoonotic Disease SurveillanceZoonotic Disease Surveillance

• Adapt RODS to …– Veterinary Diagnostics Laboratory

• Lab orders batched & transmitted via ftp• Parsed into syndrome categories based

on previous mapping of tests• Spatial/temporal analysis at the ZIP code-

level– Veterinary Clinic

• Reason for Visit field included• Near real-time export via ftp• Co-co classifier parses free text into

syndrome category• Spatial/temporal analysis at the ZIP code-

level

EmergencyDepartment

CategorizeInto

SyndromesDailyTotals

TotalsHigher ThanExpected?

HistoricalModels

Alert

ReviewTrends

Chief Complaint andPatient Demographics

In HL7 messages

Daily

Continuous

Continuous

Updated monthly

ValidAlert?

InitiateResponse

Areas for Attention & AssistanceAreas for Attention & Assistance

Identified NeedsIdentified Needs

• User Training → 1:1 & Conference Workshops• User Protocols → Developed Protocol Document• User Support → 24/7 Coverage Pilot• 24/7 Coverage → System Enhancement to Permit

Alerts to Jurisdictions• Advisory Group(s) → Expansion of ODRS Advisory

Committee• Integration with Other Surveillance Systems →

Ongoing Evaluations and Study Projects• Local Health Department Resources → ?

Questions?Questions?

Loren Shaffer

Loren.Shaffer@odh.ohio.gov

614-728-3343