Using Syndromic Surveillance for All-Hazards Public Health Surveillance: Successes, Challenges, and the Future

Abstract

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

Syndromic Surveillance of Suicidal Ideation and Self-Directed Violence — United States, January 2017–December 2018

“…Thus, the reported findings should not be interpreted as exact case counts of suicidal ideation, self-directed violence, or both. Finally, without state or local context on the events, patterns, or behaviors of health systems and their patients, aggregating state and local syndromic surveillance data to the national or regional level might have less utility than would a methodology incorporating this local-level information into an early warning system for unusual patterns or potential clusters of nonfatal suicide-related outcomes (3)(4)(5).…”

“…However, deaths from suicide represent only a small part of a larger problem because each year millions of persons experience suicidal ideation and engage in suicidal and nonsuicidal selfdirected violence, both risk factors for suicide (2). Emergency departments (EDs) are an important setting for monitoring these events in near real time (3)(4)(5). From 2001 to 2016, ED visit rates for nonfatal self-harm increased 42% among persons aged ≥10 years (1).…”

Vital Signs: Trends in Emergency Department Visits for Suspected Opioid Overdoses — United States, July 2016–September 2017

“…Hospital billing data from 2014 indicate that approximately 92,000 ED visits occurred for unintentional, nonfatal opioid overdoses ( 5 ), but the time lag poses challenges to monitoring and response. ED syndromic data are important for tracking public health outbreaks ( 6 ) and can potentially identify changes in opioid overdoses quickly. Compared with billing data, syndromic data are collected in near real-time and can be viewed within 24–48 hours of an ED visit.…”

The intersection of genomics and big data with public health: Opportunities for precision public health

“…Overcoming these challenges will require an investment and recruitment of talent. For example, one recent success is the CDC’s National Syndromic Surveillance Program, which capitalized on prior investment in BioSense, modernized its systems, partnership, and tools to create a national community of practice that made contributions to public health, not only every day but in times of local and national emergency [ 60 , 61 ].…”