Published on April 16, 2008
Super Bowl Surveillance: Super Bowl Surveillance A Practical Exercise in Multi-Jurisdictional Data Sharing Carol Sniegoski1, MS, Wayne Loschen1, MS, Shandy Dearth2, MPH, Joseph Gibson2, MPH, PhD, Joseph Lombardo1, MS, Michael Wade3, MPH, MS, Matthew Westercamp4, MS, Richard Wojcik1, MS, Guoyan Zhang5, MD, MPH 1 The Johns Hopkins University Applied Physics Laboratory 2 Marion County Health Department 3 Indiana State Department of Health 4 Cook County Department of Public Health 5 Miami-Dade County Health Department This presentation was supported by Grant Number P01 CD000270 from the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC. Mass Gatherings: Mass Gatherings Pre-planned Public Mass gatherings Feb 4, 2007 South Florida Pop 2,300,000 The Hajj Jul 4, 2007 Washington, DC Pop 580,000 500,000 attendees Average stay: hours 112,000 visitors Average stay: 4-5 days 2,500,000 pilgrims Average stay: 40 days Held for a specific limited time period Attended by large numbers of people (1,000+; published reports are usually 25,000+) Fourth of July Celebration Super Bowl XLI Dec 28 – Jan 2, 2007 Mecca, Saudi Arabia Pop 1,500,000 Concentrated crowds created by temporary planned population movements Health Implications: Health Implications Arbon P, Bridgewater FH, Smith C. Mass gathering medicine: a predictive model for patient presentation and transport rates. Prehospital Disaster Med 2001, 16:150-158. Milsten AM, Maguire BJ, Bissell RA, Seaman KG. Mass-gathering medical care: a review of the literature. Prehospital Disaster Med 2002, 17:151-162. Effects on Infectious Disease: Effects on Infectious Disease Aspects of Mass Events with Implications for Infectious Disease Risk* Primary Aspects Secondary Aspects Increase in population and population density Population movement Infrastructure strain New services and behaviors Aspect of Mass Event Potential Effects on Infectious Disease Risk Increase in absolute number of cases Increase in frequency of interpersonal contact Increase in proximity of interpersonal contact Locals are exposed to visitors’ diseases Visitors are exposed to local diseases Visitors carry disease home Terrorism target Manmade pathogen release Breakdown in PH safeguards, e.g. food safety, water quality, public toilets * Adapted from Schenkel K, Williams C, Eckmanns T, Poggensee G, Benzler J, Josephsen J, et al. Enhanced surveillance of infectious diseases: the 2006 FIFA World Cup experience, Germany. Eurosurveill. 2006 December 2006;11(12):234-9. Poor hygiene in new temporary food outlets Increase in risky sexual behaviors Population Movements and Surveillance: Population Movements and Surveillance Gathering Venue External Population Sources Visiting population brings in external disease Visiting population takes back locally acquired disease Surveillance for disease brought to venue locale Surveillance for disease brought back from venue locale Local population is exposed to external disease Visiting population is exposed to local disease Surveillance for disease of local origin Surveillance for disease brought into venue locale Previous Practices: Previous Practices How much effort does it take? What surveillance data/information is shared? With whom? In what form? Summer Olympics Winter Olympics Super Bowl World Cup Review of enhanced surveillance practices at selected mass gatherings* * As reported in literature found in PubMed, MMWR, Eurosurveillance, or Google Scholar. Publications were sought on the past six events of each type: Summer Olympics, Winter Olympics, Super Bowl, and World Cup. How Much Effort?: How Much Effort? Step up existing notifiable disease surveillance: shorten reporting period Establish drop-in biosurveillance system: install, train, monitor Routine use of existing notifiable disease surveillance Establish new notifiable disease surveillance Step up monitoring of existing biosurveillance system Routine use of existing biosurveillance system Step up existing notifiable disease surveillance: increase conditions covered Add new conditions to existing biosurveillance system Low Operational Effort High Operational Effort Low Setup Effort High Setup Effort What Is Shared?: What Is Shared? Data: Information: Uninterpreted facts or values independent of assigned meaning Interpreted data that describe the past or present Raw Data Cleansed Data Aggregated Data Univariate Analysis Multivariate Analysis Expert Interpretation 01-15-07| Fevr / CP | 54 | M | 487.0 01-15-07 | Fever Chest Pain | 54 | M | 487.0 | Respiratory | DATA INFORMATION “Would suggest no reaction. However, we should be watchful of the GI syndrome among the 0-4 age group tomorrow” ... Who Is It Shared With?: Who Is It Shared With? Multiple jurisdiction population sources Multiple jurisdiction venues e.g., World Cup Single jurisdiction population sources INTRA-JURISDICTIONAL INTER-JURISDICTIONAL POPULATION SOURCES VENUE In What Form?: In What Form? Structured Data Free text alert interpretations Free text outbreak reports Aggregated data counts Raw case data Alert p-values and meta-information Unstructured Information Previous Practices: Previous Practices Year Event Use of Enhanced Surveillance at Selected Mass Gatherings* * As reported in literature found in PubMed, MMWR, Eurosurveillance, or Google Scholar. Publications were sought on the past six events of each type: Summer Olympics, Winter Olympics, Super Bowl, and World Cup. Olympics, Summer Olympics, Winter Super Bowl World Cup 1984 1986 1988 1990 1992 1994 1996 1998 2000 2001 2002 2003 2004 2005 2006 2007 Tampa, FL New Orleans, LA San Diego, CA Houston, TX Jacksonville, FL Detroit, MI Miami, FL LA County, CA Seoul, Korea Barcelona, Spain Atlanta, GA Sydney, Australia Athens, Greece Calgary, Canada Albertville, France Lillehammer, Norway Nagano, Japan Salt Lake City, UT Torino, Italy France Italy Korea & Japan USA Germany Enhanced Surveillance Including Syndromic KEY Enhanced Surveillance Mexico Previous Practices: Previous Practices Enhanced Surveillance Practices at Selected Mass Gatherings Year Venue Event Surveillance 1984 – Summer Olympics – Los Angeles Augmented n.d. reporting. Collected reportable data & syndrome counts by phone 3x/wk. 1992 – Summer Olympics – Barcelona Augmented n.d. reporting by adding diseases and increasing frequency. 1996 – Summer Olympics – Atlanta Augmented lab reporting. Created surveillance for Olympic clinics, envir. health. 1998 – World Cup – France ‘Activated’ n.d. reporting. Created computer system to analyze data & produce reports. 2000 – Summer Olympics – Sydney Augmented n.d. reporting. Created surveillance for sentinel EDs, Olympic clinics, cruise vessels, food safety, envir. health, global epi news. 2001 – Super Bowl – Tampa Created STARS. 2002 – Winter Olympics – Salt Lake City Created ALERT. Installed drop-in RODS. 2002 – World Cup – Korea & Japan Japan: Used web-based nat’l Emergency Medical Info System for new syndromic surveillance. 2004 – Summer Olympics – Athens Created environmental health inspection system with daily reports. 2005 – Super Bowl – Jacksonville Created BioDefend. 2006 – Winter Olympics – Torino Italy: Augmented n.d., lab, sentinel ILI, and toxic exposure reporting by increasing frequency. Created manually coded syndromic surveillance. France: Created reporting systems for mortality, labs, limited n.d., ED. Produced weekly summary reports. 2006 – World Cup – Germany Augmented n.d. reporting in nat’l SurvNet web system by increasing frequency. Required daily summary reports from local PH. – – Level of Effort: Level of Effort Low Operational Effort High Operational Effort Low Setup Effort High Setup Effort 1984 SO LA (augmented) 1996 SO Atlanta (augmented & created) 1992 SO Barcelona (augmented) 2000 SO Sydney (augmented & created) 2004 SO Athens 2002 WO SLC (ALERT, drop in RODS) 2006 WO Torino (augmented & created) 2001 SB Tampa (STARS) 2005 SB Jacksonville (BioDefend) 1998 WC France (‘activated’; created analysis system) 2002 WC Japan & Korea (created on existing IT) 2006 WC Germany (augmented on existing IT) What Is Shared/With Whom?: What Is Shared/With Whom? Intra-jurisdictional Data Inter-jurisdictional Information 1984 SO LA (counties) 1996 SO Atlanta (counties) 1992 SO Barcelona (in city) 2000 SO Sydney (regional) 2004 SO Athens (by county) 2002 WO SLC (email alert notifications to PH) 2006 WO Torino (nat’l & regional) 2001 SB Tampa (in county) 1998 WC France (national) 2002 WC Japan & Korea (national) 2006 WC Germany (national; publicly available) 2005 SB Jacksonville (counties) 2005 SB Jacksonville (email alerts to PH) 1998 WC France (nat’l reports publicly available) 2006 WC Germany (local & nat’l reports publicly available) 2004 SO Athens (env. reports sent to nat’l ministry) 2006 WO Torino (daily report publicly available) 2002 WC Japan & Korea (daily local & nat’l stats reports) Super Bowl XLI, 2007: Super Bowl XLI, 2007 Chicago Bears play Indianapolis Colts in South Florida Indianapolis Chicago Miami All three regions routinely practice biosurveillance Cook County Department of Public Health Marion County Health Department Indiana State Department of Health Miami-Dade County Health Department Miami and Cook County produce routine daily surveillance summary reports Super Bowl Surveillance: Super Bowl Surveillance Augmented existing biosurveillance systems/practices for the Super Bowl period Super Bowl Surveillance: Super Bowl Surveillance Setup effort: MINIMAL Operational effort: MINIMAL Planning took place during joint phone calls the week before the event. PH departments were unwilling/unable to share data but interested in sharing information. JHUAPL remotely introduced new zip code groupings into the Miami system. System was operational within 24 hours. Miami emailed extra copies of its routine daily summary report. Chicago and Indiana received extra emails containing Miami’s reports. How much effort? Miami monitored the new Chicago and Indiana zip code groupings. Shared reports were readily understood due to participating departments’ using similar surveillance systems. Super Bowl Surveillance: Super Bowl Surveillance Significance: Significance Ease of setup and operation Venue PH able to specifically surveil both venue and source populations Approach to data and information sharing: Collect and analyze data locally, share information inter-jurisdictionally Venue and source PH engaged in two-way information exchange Structured Information Sharing in Disease Surveillance Systems Wayne Loschen et al. Enhancing Event Communication in Disease Surveillance: ECC 2.0 Nathaniel Tabernero et al. Leveraged existing biosurveillance systems and practices No new data collection was needed No additional training was needed Departments’ familiarity with automated biosurveillance systems facilitated report sharing Keeping data local avoids the difficulties of inter-jurisdictional data sharing Analyzing data locally captures local knowledge Sharing only information inter-jurisdictionally is efficient and captures local knowledge Key data fields and visualization tools already available in biosurveillance system Mutually comprehensible summary reports shared between participating locales Questions?: Questions? Wayne.Loschen@jhuapl.edu http://essence.jhuapl.edu
Structured Information Sharing in Disease Surveillance Systems PHIN_2007_1 . Structured Information Sharing in Disease Surveillance Systems . 2007 ISDS
SURVEILLANCE EVENT 8/25 ... 2007/powerpoint/Loschen_SuperBowlSurveillance_1.1.ppt. ... Post-Exclusivity Adverse Event Review for Tamiflu 1 .