Coordinated Enhanced Surveillance with Healthcare Entities for Mass Gathering Events
Authors: Austin Erin E. 
Published: May 2017

ObjectiveTo describe the planning strategies and lessons learned by theVirginia Department of Health (VDH) when conducting enhancedsurveillance during mass gathering events and coordinating withhealthcare entities to distinguish event-related emergency department(ED) visits from community-related ED visits.IntroductionMass gatherings can result in morbidity and mortality fromcommunicable and non-communicable diseases, injury, andbioterrorism. Therefore, it is important to identify event-related visitsas opposed to community-related visits when conducting publichealth surveillance1. Previous mass gatherings in Virginia havedemonstrated the importance of implementing enhanced surveillanceto facilitate early detection of public health issues to allow for timelyresponse2.MethodsBetween June 2015 and September 2015, VDH coordinatedwith two healthcare entities representing six acute care hospitalsto conduct enhanced surveillance for the 2015 World Police andFire Games and 2015 Union Cycliste Internationale (UCI) RoadWorld Championships. VDH established initial communicationwith each healthcare entity between 1 week to 2 months before theevent start date to discuss functional requirements with technical,informatics, and clinical staff. Requirements included: 1) health careentity identifying gathering attendees during the ED registration, 2)capturing a standardized mass gathering indicator within the patient’selectronic health record (EHR), and 3) transmitting the gatheringindicator to VDH through existing electronic syndromic surveillancereporting processes. ED visit records with the gathering indicator wereanalyzed by VDH using the Virginia Electronic Surveillance Systemfor the Notification Community-based Epidemics (ESSENCE) andfindings were incorporated in daily VDH situational reports. Thissame methodology will be applied for the upcoming U.S. VicePresidential Debate in October 2016.ResultsThe duration of the two gatherings in 2015 ranged from 9 to 10 daysand the locations were categorized as urban. The population densityof the gathering location ranged from 1,950 to 2,889 populationper square mile. The estimated number of attendees ranged from45,000 to 400,000. Attendees were defined as having attended at leastone day of the mass gathering event. The mass gathering indicatorcaptured during the ED registration included the gathering acronymor a gathering specific field with a drop down menu containingtrue/false options. VDH utilized ESSENCE to identify 42 ED visits(0.5%) with the gathering acronym out of 8,768 total ED visits duringthe 2015 World Police and Fire Games and 60 ED visits (2.6%)with the gathering specific field out of 2,296 total visits during the2015 UCI Road World Championships. The results of the U.S. VicePresidential Debate in October 2016 are pending.ConclusionsIn 2015, VDH partnered with two healthcare entities to conductenhanced surveillance during two mass gatherings. Although VDHroutinely uses syndromic surveillance data to identify issues of publichealth concern, it has previously lacked the ability to identify EDvisits specific to mass gatherings. Prior to collaboration with VDH,the healthcare entities did not capture gathering-specific ED visitsusing their EHR systems. The two healthcare entities successfullymodified their business procedures and EHR system to capture andtransmit a gathering indicator for ED visits despite some challenges.These challenges include constraints with customization of theEHR and syndromic surveillance systems, lack of standardizedtraining among ED registration staff for interpreting and applyingthe gathering indicator, and limited functionality testing prior tothe event. Lessons learned from this coordinated effort are to: 1)initiate the planning phase and identification of requirements as earlyas possible to ensure they are well defined and understandable, 2)implement frequent communications with the healthcare entity,and 3) customize requirements for the specific gathering as muchas possible while balancing the burden and benefit to public healthand the healthcare entity. The coordinated enhanced surveillanceefforts provided both VDH and the healthcare entities with improvedsituational awareness and capacity building during mass gatheringevents. The strategies and lessons learned from these two events willbe applied to improve enhanced surveillance of public health issuesduring future mass gatherings, including the U.S. Vice PresidentialDebate in October 2016.