Background: In June 2008, burning peat deposits produced haze and air pollution far in excess of National Ambient Air Quality Standards, encroaching on rural communities of eastern North Carolina. Although the association of mortality and morbidity with exposure to urban air pollution is well established, the health effects associated with exposure to wildfire emissions are less well understood.Objective: We investigated the effects of exposure on cardiorespiratory outcomes in the population affected by the fire.Methods: We performed a population-based study using emergency department (ED) visits reported through the syndromic surveillance program NC DETECT (North Carolina Disease Event Tracking and Epidemiologic Collection Tool). We used aerosol optical depth measured by a satellite to determine a high-exposure window and distinguish counties most impacted by the dense smoke plume from surrounding referent counties. Poisson log-linear regression with a 5-day distributed lag was used to estimate changes in the cumulative relative risk (RR).Results: In the exposed counties, significant increases in cumulative RR for asthma [1.65 (95% confidence interval, 1.25–2.1)], chronic obstructive pulmonary disease [1.73 (1.06–2.83)], and pneumonia and acute bronchitis [1.59 (1.07–2.34)] were observed. ED visits associated with cardiopulmonary symptoms [1.23 (1.06–1.43)] and heart failure [1.37 (1.01–1.85)] were also significantly increased.Conclusions: Satellite data and syndromic surveillance were combined to assess the health impacts of wildfire smoke in rural counties with sparse air-quality monitoring. This is the first study to demonstrate both respiratory and cardiac effects after brief exposure to peat wildfire smoke.

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Timely public health interventions reduce heat-related illnesses (HRIs). HRI emergency department (ED) visit data provide near real-time morbidity information to local and state public health practitioners and may be useful in directing HRI prevention efforts. This study examined statewide HRI ED visits in North Carolina (NC) from 2008-2010 by age group, month, ED disposition, chief complaint, and triage notes. The mean number of HRI ED visits per day was compared to the maximum daily temperature. The percentage of HRI ED visits to all ED visits was highest in June (0.25%). 15-18 year-olds had the highest percentage of HRI visits and were often seen for sports-related heat exposures. Work-related HRI ED visits were more common than other causes in 19-45 year-olds. Individuals ≥65 years were more likely admitted to the hospital than younger individuals. The mean daily number of HRI ED visits increased by 1.4 for each 1°F (degree Fahrenheit) increase from 90°F to 98°F and by 15.8 for each 1°F increase from 98°F to 100°F. Results indicate that HRI prevention efforts in NC should be emphasized in early summer and targeted to adolescents involved in organized sports, young adults with outdoor occupations, and seniors. At a maximum daily temperature of 98°F, there was a substantial increase in the average daily number of HRI ED visits. ED visit data provide timely, sentinel HRI information. Analysis of this near real-time morbidity data may assist local and state public health practitioners in identification of HRI prevention strategies that are especially relevant to their jurisdictions.

Fifteen years have passed since the Public Health Security and Bioterrorism Preparedness and Response Act of 2002 called for the establishment of nationwide surveillance and reporting mechanisms to detect bioterrorism-related events. 1,2 In the 1990s, several health departments established surveillance systems to detect prediagnostic (ie, before diagnoses are confirmed) signs and symptoms for the early identification of disease occurrences. However, it was the 2002 act, following the September 11 and anthrax attacks, that provided the impetus and resources for the growth of syndromic surveillance across the country. 3-5 Syndromic surveillance is now a core component of many US health departments' surveillance activities. Public health practitioners use it daily to identify potential events of public health concern, track disease trends, and inform responses to confirmed and rumored events. Syndromic surveillance also provides real-time information for health events that are not supported by case reporting or laboratory reporting, such as injuries and suicidality. This supplemental issue of Public Health Reports contains 18 articles that describe the use of syndromic surveillance for event identification, situational awareness, and enhanced response to diseases, conditions, and activities that affect population health. The data used in syndromic surveillance can come from various sources, but the articles in this supplement focus on the use of electronic health record (EHR) data from clinical settings. The articles describe the value of real-time data for public health decision making and the challenges of collecting and interpreting data that are generated primarily for health care practice and billing purposes. An All-Hazards Surveillance Approach Public health agencies have historically partnered with health care delivery organizations to share patient encounter data for public health surveillance. EHR data from hospitals, urgent care centers, and other health care settings can augment traditional public health surveillance methods, such as case reporting, registries, and telephone-based surveys. As

Ninety-one per cent of survey respondents (n = 29) agreed or strongly agreed that their ability to access timely ED data was vital to inform community-level overdose prevention work. Providing LHDs with access to local, timely data to identify pockets of need and engage stakeholders facilitates the practice of informed injury prevention and contributes to the reduction of injury incidence in their communities.