bluuebunny/crossref_metadata_2025 huggingface dataset:
Carbapenem Resistant Enterobacteriaceae infections in Houston, Texas: An outline
Authors: Rehman Hafeez , Shaikh Imran , Muhetaer Kasimu , Khuwaja Salma
Published: May 2017

ObjectiveTo examine demographic as well as clinical characteristics of theCarbapenam Resistant Enteriobacteriacae (CRE) Organisms cases inHouston, Texas, 2015-2016IntroductionAccording to CDC, CRE is used to describe bacteria that are non-susceptible to one or more carbapenems; doripenem, meropenemor imipenem and resistant to third generation cephalosporins likeceftriaxone, cefotaxime and ceftazidime. These organisms causeinfections that are associated with high mortality rates and they havethe potential to spread widely. Antibiotic resistant bacteria causemore than 2 million illnesses and at least 23,000 deaths each year inUnited States. CREs are found in many health care settings like acutecare hospitals, long term care facilities, nursing homes, rehabilitationfacilities and other health care settings. Although CREs includes anumber of species, reporting in State of Texas is limited to CRE-Klebsiellaspecies and CRE-E.coli.MethodsPopulation-based surveillance data was generated from Houston’selectronic disease surveillance system reported to Houston HealthDepartment (HHD) from October 2015 to July 2016. Descriptiveanalysis was performed to examine demographic and clinicalcharacteristics across different age groups, gender and race/ethnicity.HHD has received a total of 463 CRE cases during the time period,out of which 72 were non-reportable and did not meet the casecriteria, 187 were out of jurisdiction. The remaining 204 cases wereincluded in this study.ResultsOut of a total of 204 cases, males and females were representedequally (50% each). The mean age of the cases was 67 years(age ranges from 22-98). Majority of the cases were in the older agegroup, 70 years and above 53 (26%), followed by 48 (24%) in agegroup 80 and above years. Among the different race/ethnic groups,African-Americans comprised of 82 (40%), followed by Whites67 (33%) and Hispanics 33 (16%). Out of 204 cases, 156 (76%)were hospitalized, which included acute care hospital, long-termacute care or nursing home. Out of 156 hospitalized cases, 71 (34%)were in Intensive Care Unit (ICU) and 136 (67%) had an invasiveor indwelling device. Of all the cases, 80% had CREKlebsiellapneumoniae, followed by 11% who had CRE- E coli. The cases weredistributed evenly across the city when plotted on ArcGIS with theirresidential addresses.ConclusionsCRE cases are found to be more common among older age groups,African American population and in hospitalized patients. CRE canbe a ground for increasing infectious diseases in the community andone of the reason may be unnecessary use of antimicrobial agents.This study provides a glimpse into the number of CRE cases reportedin Houston since CREs are classified a separate disease in Texas.Further studies are needed to explore the occurrence of anti-microbialdrug resistance among the specific population groups and how thecase investigation efforts can be targeted to enhance prevention.
Progress towards rabies elimination from Pemba Island, Southern Tanzania
Authors: Lushasi Kennedy S. , Cleaveland Sarah , Changalucha Joel J. , Haydon Daniel , Kazwala Rudovick , Lembo Tiziana , Masoud Msanif , Maziku Mathew , Mchau Geofrey , Mtema Zacharia , Omar Kassim , Maganga Sambo , Rysava Kristyna , Hampson Katie
Published: May 2017

ObjectiveUsing active surveillance approaches to investigate the transmissiondynamics of rabies on Pemba Island and across Southern Tanzania,whilst a large-scale dog vaccination program was underway1, to gaina greater understanding of the dynamics of infection as the disease isdriven towards elimination.IntroductionRabies is endemic in Tanzania and has circulated on Pemba Islandsince the late 1990s. In 2010, an elimination programme was initiatedin Southern Tanzania to demonstrate that human rabies deathscan be eliminated through mass dog vaccinations. We used activesurveillance approaches2to investigate the dynamics of rabies acrossthe area where this programme was implemented.MethodsGovernment census data and post-vaccination transects were usedto estimate the dog population and coverages achieved by vaccinationcampaigns. Routine surveillance of animal bite injuries using a mobilephone-based surveillance system3and active contact tracing wereused to identify animal rabies cases and human exposures. Epidemictrees were constructed using spatiotemporal distances between casesand used to estimate the effective reproduction number (Re). Weexamined factors affecting rabies incidence and transmission usinggeneralized linear mixed models.ResultsWe estimated a small dog population of 4095 and low dog:humanratio on Pemba (1:105). Overall island-wide vaccination coverageincreased from 16.8% in 2011 to 68.2% in 2014. We found a further48 human exposures (343%), who either were not reported or did notobtain post exposure prophylaxes (PEP). Routine surveillance wasfound to detect less than 10% (~8.75%). There was a rapid declinein cases detected on Pemba, from 42 before mass dog vaccinationswere implemented in 2011, to 2 cases in 2014 (Figures 1). Since May2014, no rabies cases have been detected. Similarly, Redeclined from1.02 to 0 and a significant relationship was found with rabies casesdecreasing with increasing vaccination coverage (p= 0.013, Figure 2).Across seven other districts on the Tanzanian mainland we alsoobserved major declines in rabies cases with very few cases of rabiesin dogs detected in 2016 (Figure 3).ConclusionsWe conclude that rabies has been eliminated from domestic dogpopulations on Pemba over the five years since vaccination campaignshave been implemented. Continued surveillance and investigationsof any bite incidents are therefore needed to ensure any subsequentincursions are controlled and freedom from rabies is maintained.On the Tanzanian mainland, it has taken longer to control rabies,however trajectories look promising with several districts close toeliminating the disease. However, detection of some wildlife casesin the last 12 months in these districts indicates the need to furtherinvestigate remaining foci and the role of wildlife in maintenance.
Using Syndromic Surveillance Data to Monitor Endocarditis and Sepsis among Drug Users
Authors: Deyneka Lana , Hakenewerth Anne , Faigen Zachary , Ising Amy , Barnett Clifton
Published: May 2017

ObjectiveTo describe how the state syndromic surveillance system(NC DETECT) was used to initiate near real time surveillance forendocarditis, sepsis and skin infection among drug users.IntroductionRecreational drug use is a major problem in the United States andaround the world. Specifically, drug abuse results in heavy use ofemergency department (ED) services, and is a high financial burdento society and to the hospitals due to chronic ill health and multipleinjection drug use complications. Intravenous drug users are at highrisk of developing sepsis and endocarditis due to the use of a dirty orinfected needle that is either shared with someone else or re-used. Itcan also occur when a drug user repeatedly injects into an inflamedand infected site or due to the poor overall health of an injection druguser. The average cost of hospitalization for aortic valve replacementin USA is about $165,000, and in order for the valve replacement tobe successful, patients must abstain from using drugs.MethodsWe examined temporal trends of drug-related visits to hospitalEDs, as well as drug-related related ED admissions complicated withendocarditis, bacteremia and sepsis.ResultsThe trends in Endocarditis/Sepsis and drug-related relatedadmissions appear to echo overdose related ED admissions increase.Patients ED return visits and hospitalizations for the same problem arealso growing compare to the previous years. We will discuss the NCDETECT case definition used to monitor drug overdose/dependenceand infection, case definition transition from ICD-9 to ICD-10 codes,and will share surveillance analysis results.ConclusionsNC DETECT’s system flexibility has been important in rapidlyestablishing surveillance of infections among drug users. Near realtime analysis on hospital, county and state levels can be performedusing NC DETECT system reports to provide state officials, hospitalsand LHDs with situational awareness. Limitations: Syndromicsurveillance ED data contains less accurate information about thediagnosis codes, procedures, length of stay, and severity comparingto the hospital discharge data.
Development and pilot study road traffic injury surveillance, Kaduna Nigeria
Authors: Babalola Obafemi J.
Published: May 2017

ObjectiveWe pilot a RTI surveillance system using data from FRSC, Policemotor traffic division and Health facilities in Kaduna metropolis,Nigeria to ascertain its feasibility and generate data needed for actiontoward achieving sustainable development goals 3.6 target.IntroductionRoad Traffic Injury is common cause of unintentional injuryglobally and Low and middle income countries account for 90%of 1.3 million Road Traffic Injury (RTI) deaths. In Africa region,Nigeria accounts for 25% of RTI mortality but has no comprehensiveand reliable RTI surveillance system. Data from Federal RoadSafety Commissions (FRSC) shows gaps in RTI reporting with largedisparity with estimated value from World Health Organization.MethodsKaduna metropolis is the capital of Kaduna State with estimatedpopulation of 1.96 million. It is a major route between Abuja, theNational capital and 15 northern Nigeria states with high vehicularmovement. We adapted WHO Injury surveillance guideline andCenters for Disease Control and Prevention surveillance trainingmanual for this study. A case of RTI is any person injured or diedwithin 30 days as a result injuries incurred from vehicular collision ona public road in Kaduna Metropolis. Data collected using a pretestedquestionnaire for RTI cases at health facilities, Police and FRSC.Data were linked by deterministic method, cleaned and analysed.Frequency and proportion were calculated to characterize the RTI.The study was supported by a mini-grant from Center for DiseaseControl and Prevention.ResultsData was collected from February to April 2016. Of the 324crashes reported, 566 people injured and 66 deaths with case fatalityrate of 11.7%. Male gender accounts for 81.8% and age 20 – 39 yearswere 64.6%. Commercial drivers were 20.7%, pedestrian 21% andpassengers were 53.7%. Sixty percent of the crash occurred betweencars or buses while 21% were without collision with any vehicle orstationary objects. Of the 66 deaths reported 61(92.4%) died at crashsite. FRSC evacuated 21%, 38.6% were evacuated by other road users.No use of seat belt and crash helmets reported and only 5.1% receivedfirst aid care before reaching reporting facility. RTI Incidence peakedbetween 6:00 PM to 8:59 PM with 26 persons per hour.ConclusionsEssential to sustainable development goal 3, a multisectorRTI surveillance system that generate data for action in Kadunametropolis, Nigeria is feasible and data generated was used for actionat different levels to mitigate against the burden of RTI
Firearm Injury Encounters in the Veterans Health Administration (VHA), 2010-2015
Authors: Lucero-Obusan Cynthia , Wendelboe Aaron , Schirmer Patricia , Oda Gina , Holodniy Mark
Published: May 2017

IntroductionFirearm violence is an issue of public health concern leading tomore than 30,000 deaths and 80,000 nonfatal injuries in the UnitedStates annually.1To date, firearm-related studies among Veteranshave focused primarily on suicide and attempted suicide.2-5Herein,we examine firearm violence among VHA enrollees for all manners/intents, including assault, unintentional, self-inflicted, undeterminedand other firearm-related injury encounters in both the inpatient andoutpatient settings.MethodsInpatient and Outpatient encounters with one or more ICD-9-CM firearm external-cause-of-injury codes (E-codes) from1/1/2010-9/30/2015 were extracted from the VHA’s Praedico™Public Health Surveillance System, including demographics, era ofservice/eligibility, encounter type, and deaths. Firearm E-codes wereclassified for manner/intent based on the CDC’s Web-based InjuryStatistics Query and Reporting System (WISQARS™) matrix.6Outpatient/emergency department (ED) data were exclusively fromVHA facilities (a single pediatric patient seen as a humanitarianemergency was excluded from the dataset). Inpatient data includedVHA facilities and some records received from non-VHA facilities.VHA rate of hospitalization for firearm-related admissions wascalculated using the total VHA acute-care admissions for the sametime period as the denominator.ResultsDuring the time frame examined, 5,205 unique individuals wereseen with a firearm E-code. Of these, 4,221 were seen in the outpatient/ED setting only, 597 in the inpatient setting only, and the remaining387 had encounters in both the outpatient/ED and inpatient settings.VHA firearm admission rate was 1.63 per 10,000 VHA admissions,compared to a national rate of 1.96 per 10,000 in 2010.7Table 1 showsthe breakdown of encounters by manner/intent. Unintentional was themost common firearm injury manner/intent. Overall, the median age atinitial encounter was 54 (range 19-100 years), and 96% were male. Thehighest percentage served in the Persian Gulf War Era (2,136, 41%),followed by Vietnam Era (1,816, 35%) and Post-Vietnam Era (716,14%). The greatest number of patients with a firearm-coded encounterresided in Texas (453), California (349), Florida (326), Arizona (214)and Ohio (212).ConclusionsUnintentional injuries were the most common form of firearminjury among VHA enrollees, representing over half of alloutpatient/ED firearm encounters and more than twice the numberof firearm hospitalizations compared with any other manner/intent.Limitations include that not all U.S. Veterans are VHA enrollees;miscoding and misclassification of firearm-related injuries may haveoccurred; and data from non-VHA outpatient/ED encounters andsome non-VHA hospitalizations are not available to our surveillancesystem for analysis. Additional study is needed to further understandthe epidemiology of firearm-related injuries among Veterans andinform VHA leadership and providers
Monitoring child mental health related emergency department visits in New York City
Authors: Olson Don , Van der Mei Willem , Lim Sungwoo , Yoon Carol , Kull Melissa , Davila Marivel
Published: May 2017

ObjectiveTo assess the use of syndromic surveillance to assess trends inmental health-related emergency department (ED) visits amongschool-aged children and adolescents in New York City (NYC).IntroductionFrom 2001-2011, mental health-related hospitalizations and EDvisits increased among United States children nationwide [1]. Duringthis period, mental health-related hospitalizations among NYCchildren increased nearly 23% [2]. To estimate mental health-relatedED visits in NYC and assess the use of syndromic surveillance chiefcomplaint data to monitor these visits, we compared trends from anear real-time syndromic system with those from a less timely, codedED visit database.MethodsThe NYC ED syndromic surveillance system receives anonymizedpatient chief complaint and basic demographic data for nearly everyED visit citywide to provide timely surveillance information tohealth authorities. Using NYC ED syndromic surveillance datafrom 2003-2015, we applied previously developed definitions forgeneral psychiatric syndromes. We aggregated ED visits by agegroup (5-12 years, 13-17 years, and 18-20 years), geography, andtemporality. Syndromic data were compared with Statewide Planningand Research Collaborative System (SPARCS) data from 2006-2014which reported mental health diagnosis (ICD-9), treatment, service,and basic demographics for patients visiting facilities in NYC. Usingthese two data sources, we compared daily visit patterns and annualtrends overall as well as stratified by age group, area-based poverty(ZIP code), and time of visit.ResultsBoth syndromic surveillance and SPARCS data for NYC showedan increasing trend during the period. While both showed relativeincreases with similar slopes, mental health-related chief complaintdata captured fewer overall visits than the ICD-9 coded SPARCSdata. Trends in syndromic data during 2003-2015 differed by age-group and area-based poverty, e.g., among children ages 5-12 yearsthe annual proportion of mental health-related ED visits increasedroughly 3-fold from 1.2% to 3.8% in the poorest areas, which wasgreater than the increase in the richest areas (1.7% to 2.6%). Seasonal,day-of-week, and school holiday patterns found far fewer visits duringthe periods of NYC public school breaks (Figure).ConclusionsWe conclude that syndromic surveillance data can provide areliable indicator of mental health-related ED visit trends. Thesefindings suggest potential benefit of syndromic surveillance data asthey may help capture temporal and spatial clustering of events in amuch more timely manner than the >1 year delay in availability ofED discharge data. Next steps include a qualitative study exploringthe causes of these patterns and the role of various factors drivingthem, as well as use of patient disposition and matched data to bettercharacterize ED visit patient outcomes.
Seroprevalence of zoonotic diseases among farm animals in Kvemo Kartli (Georgia)
Authors: Goginashvili K. , Donduashvili M. , Osiashvili Gaga , Arner Ryan , Malania Lile
Published: May 2017

ObjectiveThe purpose of this research was to study the seroprevalence ofzoonotic diseases among farm animals in the Kvemo Kartli regionof Georgia.IntroductionZoonotic diseases are an important cause of human morbidityand mortality; around 75% of recently emerging human infectiousdiseases are zoonoses. Herein we report the first seroprevalence studyto include a range of emerging or re-emerging zoonotic pathogens ofeconomic concern (including:Bacillus anthracis, Coxiella burnetii,Francisellaspp.,Brucellaspp., and Crimean-Congo hemorrhagicfever virus (CCHFV)) affecting domestic animals (e.g., cattle, sheep,goat, and dog) in Georgia.MethodsCattle (n=177) from Gardabani, Marneuli, and Tsalka(Kvemo Kartli region) were sampled for the study as were small ruminantsand dogs (n=30).Bacillus anthracis, Brucellaspp., CCHFV, andC. burnetii(Phase I) were detected using ELISA methods.Francisellatularensiswas detected using a microscopic agglutination test (MAT).ResultsOf the cattle sampled, 11 were positive forF. tularensis, 39 werepositive forBrucellaspp., and seven were positive forC. burnetii. Allsamples were negative for CCHFV. Three goat samples were positiveforC. burnetii, one goat sample and one dog sample were positive forF. tularensis.ConclusionsDomestic animals serve as a source of disease that can spreadto humans through vectors or direct contact. In Georgia, domesticanimals were not previously studied for exposure to zoonotic diseases,with the exception of cattle, which were surveyed for brucellosis.In particular, the finding ofF. tularensisseropositive animals isnovel in Georgia, as this region was considered free of the pathogen.Screening studies of domestic/farm animals for zoonotic pathogenssuch as this can serve as a source of baseline data for regional riskassessments and to better inform One Health measures.
Spread of Clostridium botulinum in the soils of Georgia
Authors: Zhorzholiani Ekaterine , Chakvetadze Neli , Katsitadze Guram , Imnadze Paata
Published: May 2017

ObjectiveThe main focus of this study was to study the spread of botulism inGeorgia and the biological characteristics of the strains ofClostridiumbotulinumisolated from territories in the country.IntroductionAccumulation ofC. botulinumin soil occurs through excretion ofbacterial spores from the intestines of humans, animals, birds andfish. In Georgia, during the winter season, the population consumeshomemade vegetable preserves, which are made of locally produced(as well as imported) vegetables. Historical surveys confirmed that thepresence ofC. botulinumin the soil is widespread. Some researchersconsiderC. botulinuma characteristic component of soil flora.MethodsSoil samples were collected from areas, where from 2001-2002cases of botulism caused by homemade vegetable preserves (producedfrom vegetables cultivated in those areas) were registered. Soilsamples were collected from Kakheti, Shida Kartli, Kvemo Kartli,Samtkhe-Javakheti, and Samegrelo regions. Standard bacteriologyand PCR were used to confirm the presence ofC. botulinumfrom soilsamples. Separation of strains and their examination was conducted inaccordance with the scheme provided by the CDC Atlanta ReferenceLaboratory (USA), which was later tested by NCDC. Toxigenicityand toxin production of strains were tested using a biotest on whitemice.ResultsIn total, 258 soil samples were tested, from which, 40 (15.5%)cultures ofC. botulinumtype B were obtained. Toxigenicity andtoxin production were confirmed through biotests. These resultsconfirm the presence ofC. botulinumin agricultural lands, whichcauses contamination of vegetables cultivated on those lands, whichare used for the preparation of homemade preserves, causing botulismin humans.ConclusionsFor the purpose of finding solutions to botulism, it is essentialto verify the ecology of the pathogen through establishing theprevalence of bacteria in different soil types. It was shown that someareas of Georgia, where vegetable growing is greatly developed, andwhich, are the main sources of crops, are highly contaminated withC. botulinum. In Georgia, land used for agriculture is contaminatedwithC. botulinum.C. botulinumtype B was isolated from 40 culturesobtained from 258 soil samples, which represents contamination in15.5% of sampled areas. These results suggest that vegetables andmelons may be highly contaminated as well. All cases ofC. botulinumin humans that were researched were connected to homemade cannedvegetables.
What do we know about the behavior of animal rabies in Chile through the last years?
Authors: Alegria-Moran Raul , Miranda Daniela , Parra Alonso , Lapierre Lisette
Published: May 2017

ObjectiveThis study aims to analyze the evolution of the epidemiologicalbehavior of rabies in Chile during the period 2003 to 2013, throughthe epidemiological characterization of a number of variables anddescription of spatial and temporal patterns of animal cases.IntroductionRabies is a zoonotic disease caused by an RNA virus from thefamily Rhabdoviridae, genus Lyssavirus. Worldwide distributed,control of rabies has been considered to be particularly amenable toa “One Health” strategy (1). In Chile, rabies was considered endemicin domestic dog population until the late 1960s, when a surveillanceprogram was established, decreasing the number of human casesrelated to canine variants until the year 1972 (2). Rabies is recognizedas a endemic infection in chiropterans of Chile and prompted thesurveillance of the agent in this and other species (3).MethodsAn epidemiological characterization of the registered cases fromthe National Program for Prevention and Control of Rabies wascarried. During the period 2003-2013, 927 cases were reported.Descriptive statistics and descriptive mapping, recording origin of thesample, number of cases per region, animal reservoir implicated andviral variant were performed. A spatial autocorrelation analysis wascarried using Moran’s I indicator for the detection of spatial clusters(4), using the Local Indicators of Spatial Association (LISA) statistics(5), at national and regional level of aggrupation (north, central andsouth zone). Temporal descriptive analysis was carried.Results927 positive cases were recorded. 920 (99.2%) cases came frompassive surveillance, while 7 (0.8%) cases by active surveillance, totalpositivity was 77.02% and 1.37% respectively. Positivity was reportedmainly in the central zone (88.1%), mainly in Valparaiso (19.1%),Metropolitana (40.6%) (Figure 1), Maule (11.8%) regions concentratedin urban centers. Main positive reservoirs were bats (99.8%),specificallyTadarida brasiliensisand viral variant 4 was the mostcommonly diagnosed. LISA test gives a Moran’s I indicator of 0.1537(p-value = 0.02) for the central zone (Table 1). Rabies tend to decreasein fall and winter season (2.9 cases vs 13 cases during summer).ConclusionsWildlife rabies in bats remains endemic in Chile, concentrated inurban areas. The main reservoirs are insectivorous bats. There is asignificant spatial autocorrelation of animal rabies cases in the centralzone of Chile. Results are relevant to the design of preventive andcontrol measures.
Exploring the Distribution of Coccidioides immitis in South Central Washington State
Authors: Clifford Wayne
Published: May 2017

ObjectiveOur objective is to describe the environmental conditions associatedwith confirmedCoccidioides immitisgrowth and accumulation sitesin south central Washington in an effort to understand the ecology andidentify additional potential sites across this emerging endemic zone.IntroductionCoccidioidomycosis, commonly referred to as Valley Fever, iscaused by the soil-borne saprophytic fungusC. immitisandposadasii.These species have historically been found in the desert southwest andMexico; however, in 2010 there were three coccidioidomycosis casesidentified in central Washington. Colonization of soils byC. immitishas been confirmed at exposure sites associated with these cases1.Multiple studies have identified a relationship between environmentalconditions andC. immitisgrowth areas2,3,4, but these relationshipshave not been evaluated in Washington. The Washington StateDepartment of Health has been conducting environmental surveillancein an effort to understand the geographic distribution ofC. immitisincentral Washington and the associated risk to humans and animals.Here we describe our environmental surveillance efforts and presentpreliminary findings related to environmental conditions ofC. immitisgrowth areas in central Washington.MethodsWe collected soil samples at potential human exposure sites incentral Washington, as identified through clinical surveillance andpatient interviews. Soil samples were also collected from areasnot associated with human cases by looking for similar soils inareas of interest Soil samples are analyzed by the U.S. Centers forDisease Control and Prevention using real-time PCR that detectsCoccidioides-specific targets. We employed data from the USDA SoilSurvey Geographic (SSURGO) database to describe environmentalconditions associated with positive samples. We used our findingsto identify un-sampled regions of central Washington that couldpotentially supportC. immitisgrowth.ResultsWe detectedCoccidioidesin 13 soil sampling sites at fivelocations withing the region. These detections included locations notpreviously described in central Washington. We identified a bandstretching across central Yakima and Benton counties with similarsoil characteristics to our positive sample sites, which suggests theseregions could potentially support the growth ofC. immitis.ConclusionsCoccidioidomycosis is emerging in south central Washington, andthe ecology and geographic distribution of the pathogen are poorlyunderstood. We found thatC. immitispresents a risk to humans andanimals across a larger region of central Washington than previouslydescribed and highlights a need for continued environmentalsurveillance. The potential growth sites we identified also providea valuable tool for human and veterinary health care providers andpublic health practitioners to understand and mitigate disease risk.
Administrative and syndromic surveillance data can enhance public health surveillance
Authors: Anderson Tara C. , Yusuf Hussain , McCarthy Amanda , Trivers Katrina , Hicks Peter , Coletta Michael , Grigorescu Violanda
Published: May 2017

ObjectiveThis roundtable will address how multiple data sources, includingadministrative and syndromic surveillance data, can enhance publichealth surveillance activities at the local, state, regional, and nationallevels. Provisional findings from three studies will be presented topromote discussion about the complementary uses, strengths andlimitations, and value of these data sources to address public healthpriorities and surveillance strategies.IntroductionHealthcare data, including emergency department (ED) andoutpatient health visit data, are potentially useful to the publichealth community for multiple purposes, including programmaticand surveillance activities. These data are collected through severalmechanisms, including administrative data sources [e.g., MarketScanclaims data1; American Hospital Association (AHA) data2] andpublic health surveillance programs [e.g., the National SyndromicSurveillance Program (NSSP)3]. Administrative data typically becomeavailable months to years after healthcare encounters; however, datacollected through NSSP provide near real time information nototherwise available to public health. To date, 46 state and 16 localhealth departments participate in NSSP, and the estimated nationalpercentage of ED visits covered by the NSSP BioSense platform is54%. NSSP’s new data visualization tool, ESSENCE, also includesadditional types of healthcare visit (e.g., urgent care) data. AlthoughNSSP is designed to support situational awareness and emergencyresponse, potential expanded use of data collected through NSSP(i.e., by additional public health programs) would promote the utility,value, and long-term sustainability of NSSP and enhance surveillanceat the local, state, regional, and national levels. On the other hand,studies using administrative data may help public health programsbetter understand how NSSP data could enhance their surveillanceactivities. Such studies could also inform the collection and utilizationof data reported to NSSP.
Civilian-military Collaboration: Department of Defense data in the BioSense Platform
Authors: Deerin Jessica , Chretien Jean-Paul , Lewis Paul E.
Published: May 2017

ObjectiveThe Department of Defense data is available to NationalSyndromic Surveillance Program (NSSP) users to conduct syndromicsurveillance. This report summarizes the demographic characteristicsof DoD health encounter visits.IntroductionThe DoD provides daily outpatient and emergency room data feedsto the BioSense Platform within NSSP, maintained by the Centersfor Disease Control and Prevention. This data includes demographiccharacteristics and diagnosis codes for health encounter visits ofMilitary Health System beneficiaries, including active duty, activeduty family members, retirees, and retiree family members. NSSPfunctions through collaboration with local, state, and federal publichealth partners utilizing the BioSense Platform, an electronic healthinformation system.MethodsDoD data was pulled from the BioSense Platform through aRStudio server on October 11, 2016, querying data from November1, 2015 to September 30, 2016. Appointment type and beneficiarycategory data was not available in BioSense until November 1, 2015.Appointment type was categorized into clinic visits and telephoneconsults. Demographic characteristics (age group, gender, beneficiarycategory) are stratified by appointment type.ResultsDuring the time period of November 1, 2015 to September 30, 2016,data were received from 452 clinics. There is a military treatmentfacility located in 45 states and a military treatment facility mayhave one to 12 clinics. There were a total of 86,840,632 healthcareencounter records. The age group, 25-44 years, accounted for 39.4%of the medical encounters; the mean age was 33.9 (SD=19.1). Malesaccounted for 55.6% of the medical encounters. For the time periodfrom November 1, 2015 to September 30, 2016, 78.9% of medicalencounters were clinic visits. The remaining medical encounterswere telephone consults. Of the clinic visits, 53.7% of the medicalencounters were for active duty personnel.ConclusionsThis report highlights the DoD data available to NSSP users forcollaborative syndromic surveillance efforts, promoting a communityof practice. It is important to understand the population demographicsand limitations to the DoD data when conducting syndromicsurveillance.
Enhanced syndromic surveillance during the 9 th Indian Ocean Island Games, 2015
Authors: Vilain Pascal , Pages Frédéric , Henrion Guy , Combes Xavier , Weber Marc , Marianne Dit Cassou Pierre-Jean , Mougin-Damour Katia , Filleul Laurent
Published: May 2017

ObjectiveTo describe how syndromic surveillance was enhanced to detecthealth events during the 9thIndian Ocean Island Games (IOIG) inReunion Island.IntroductionThe 9thIOIG took place in Reunion Island from July 31 to August9, 2015. This sport event gathered approximatively 1 640 athletes,2 000 volunteers and several thousand spectators from seven islands:Comoros, Madagascar, Maldives, Mauritius, Mayotte, Seychelles andReunion.In response to the import risk of infectious diseases from thesecountries where some of them are endemics, the syndromicsurveillance system, which captures 100% of all EmergencyDepartment visits, was enhanced in order to detect any health event.MethodsIn Reunion Island, syndromic surveillance system is based onOSCOUR® network (Organisation de la surveillance coordonnéedes urgences) that collects data from all emergency departments ofthe island. Data are daily transmitted to the French national publichealth agency then are available to the regional office. At the regionallevel, data are integrated into an application that allows the built ofpredefined syndromic groups according to the health risks related tomass gatherings (Table 1, parts 1 to 3) and complemented by specificsyndromic groups (table 1, part 4). Daily analyses with temporal[1] and spatial-temporal [2] algorithms were performed during thesurveillance period of July 27 to August 13, 2015. In addition to thismonitoring, ED physicians were requested to proactively tag Y33(ICD-10) as secondary diagnosis, each ED visits related to IOIG. Linelists were reviewed daily. Each day, an epidemiological report wassend to public health authorities.ResultsFrom July 31 to August 9, 2015, the activity of EDs was inaccordance with that expected. No health events were detected bythe syndromic surveillance system except for the syndrome “alcoholintoxication” for which consecutive signals were observed fromAugust 6 to 9, 2015. This increase occurs commonly at the beginningof each month (due to the social benefits payday) [3] nevertheless thisevent has probably been increased by IOIG (finals for team sportsand games closing ceremony). In total, 8 ED visits were tagged Y33as secondary diagnosis. In over half the cases, visits were related totrauma.ConclusionsThe syndromic surveillance system proved to be useful for thesurveillance of mass gathering events due to its capacity to detecthealth events but also to provide reassurance public health authorities[4]. As described in literature [5], few ED visits were tagged in relationto IOIG. Indeed, the tag of ED visits was implemented two weeksbefore the games, and given the shifts of ED physicians, some of themmay have not been informed. In the future, preparation meetings withphysicians will have to be planned several months before in order toimprove the response rate for mass gathering events.
Baseline Assessment of Public Health Surveillance in the Kingdom of Swaziland
Authors: Nuwagaba-Biribonwoha Harriet , Nhlabatsi Nhlanhla , MacWright William , Lokotfwako Vusie , Trong Tony A. , Ryland Paige , Shaikh Affan , Sylvester Joy , McNabb Scott J.
Published: May 2017

ObjectiveTo assess essential support functions for Integrated DiseaseSurveillance and Response(IDSR) in the Kingdom of Swaziland andmake recommendations for a national IDSR Roadmap.IntroductionImplementation of the IDSR framework for fulfillment of theInternational Health Regulations (2005) ([IHR 2005]) has beenchallenging in Swaziland due to distribution of IDSR functions acrossunits within the Strategic Information Department (SID) and otherexternal departments within the Ministry of Health. We conducted aqualitative assessment and a Strength, Weaknesses, Opportunities andThreats (SWOT) analysis of current public health surveillance (PHS)support structures to inform implementation of IDSR.MethodsKey informant interviews, focus group discussions, and a deskreview were performed. Participants were personnel at essential units,departments and programs at the national level as well as at healthfacilities and clinics at regional and local levels. Transcripts werecoded into SWOT matrices using MAXQDA for each building blockof PHS: structures, workforce, resources, processes (detect, report,assess/analyze, respond, feedback), and informatics.ResultsSelected Strengths included existence of immediate notifiabledisease reporting through the Epidemic and Pandemic Response unit(EPR) and reporting of summary health facility data to the HealthManagement Information System (HMIS) unit and laboratorynetwork. Weaknesses included lack of clear roles and responsibilitiesfor IDSR among SID units, limited coordination between SID units,lack of data sharing, lack of Standard Operating Procedures (SOPs),uncoordinated case investigations and response, minimal analysisconducted for public health surveillance and limited feedback forreporters..Identified opportunities were political will for establishing ofroles and responsibilities and mechanisms for coordination anddata sharing. Threats were limited data access, limited funding forfeedback, lack of analysis for IDSR and paper-based reportingConclusionsCurrently there is limited use of surveillance data for decisionmaking due to lack of coordination. Findings were presented at adissemination meeting to representatives of relevant departments,and there was consensus on the need to clearly define the role andresponsibilities of different programs for IDSR. In March 2016, aconsensus meeting was held to designate roles and responsibilitiesfor IDSR, a direct result of this assessment. Additional resourcesand funding is needed to support these highly important initiatives toensure the safety and health security of the Swazi nation.
Cause of death in under 5 children in a demographic surveillance site in Pakistan
Authors: Imran Nisar Muhammad , Ilyas Muhammad , Naeem Komal , Fatima Urooj , Jehan Fyezah
Published: May 2017

ObjectiveTo identify Cause of deaths among children below age of 5yearsfrom a prospective cohort of women in one urban and four peri-urbansettings of Karachi, PakistanIntroductionPakistan ranks 26th in Childhood mortality rates, globally. Pakistan,with other 4 countries is responsible for about half of the deaths ofchildren age under 5. Despite such burden vital registration systemis not well established, health facilities are not easily accessible andmostly deaths occur at home, making identification of cause of death(COD) difficultMethodsFrom Jan 2007-Dec 2012 under-5 mortality was identifiedby CHWs during their 3-monthly visits. A Research Assistantconducted Verbal Autopsies (VA). Each VA form was analyzed by2 physicians, independently, and assigned a cause. VA is analyzedby a third physician in case two physicians do not agree on a cause.Cause Specific Mortality Fractions (CSMF) were calculated for eachidentified COD.Results833(58%) neonatal deaths and 591(42%) Under-5 deaths (excludingneonates) were identified. Among neonates most common CODswere perinatal asphyxia(30.4%), neonatal sepsis/meningitis(28%),pre-term birth complication(11%) and neonatal pneumonia(6%).For Post-neonatal deaths most common CODs were sepsis (19%),diarrheal disease (17%), Pneumonia (17%) and meningitis (8%).ConclusionsWe describe the CSMF for different CODs among neonated andchildren under 5. Strategies for prevention of most common causesand making health facilities easily accessible will decrease thisburden.
Evaluation of the Malaria Surveillance System in Kaduna State, Nigeria 2016
Authors: Ibrahim Baffa S. , Abubakar Aisha A. , Bajoga Ummulkhulthum A. , Nguku Patrick M.
Published: May 2017

ObjectiveTo describe the process of operation of the system and assessits key attributes, to determine the effectiveness and efficiency ofthe surveillance system and make appropriate recommendations tostakeholders for its improvement.IntroductionMalaria is a parasitic disease caused by Plasmodium falciparum.About 3.2 billion people worldwide are at risk of malaria.1Childrenand pregnant women are particularly vulnerable to the disease. Sub-Saharan Africa carries a high share of the global malaria burden.2Effective malaria surveillance system is essential in the control andelimination of malaria. Worldwide, there were an estimated 198million cases of malaria in 2013 and 584,000 deaths.1,3,4MethodsThis study was conducted using the “CDC’s Updated Guidelinesfor Evaluating Public Health Surveillance System, 2001”. Keystakeholders and Malaria Focal Persons were interviewed. IntegratedDisease Surveillance and Response case summary data from Januaryto December 2014 was reviewed. Data analysis was done usingMicrosoft Excel 2016 and Epi-info 7.ResultsThe system provides information on malaria trends, morbidityand mortality. Case definitions are well understood by participants.All Malaria focal persons (MFPs) were willing to continue usingthe system. Standardized data collection tools are available in 91%of Health Facilities (HF). The system was rated flexible by 91%of MFPs. The system was however not representative because datawere essentially from public health facilities only. The system hasan average timeliness of 37.7% and completeness of 59.4%, bothparameters were below the State’s 80% target. About 91% MFPs hadrefresher training, while 78% MFPs received supportive supervision.Main challenges identified were lack of commodities in all HFs, andinadequate mobile facilities in 70% of HFs.ConclusionsThe Kaduna state Malaria surveillance system is meeting itsobjectives. However, challenges are observed in its timeliness,representativeness, and data quality. Efforts should be made tointegrate tertiary and private health facilities into the system. MFPsneed more training on malaria reporting to improve timeliness anddata quality. There is the need to improve on the supply of malariatreatment commodities to all health facilities within Kaduna state.
Global Health Surveillance: Innovation and Coordination for Broad Health Impact
Authors: Ransom Ray L. , Henao Olga L. , Peruski Leonard , Kigozi Ruth , Blazes David , Bertrand William , Montgomery Joel
Published: May 2017

ObjectiveThe session will discuss strategies for outbreak prevention,detection, and response for global health security and explore howthese activities inform both domestic and international initiatives.Innovations in epidemiology, laboratory, informatics, investment, andcoordination for disease surveillance will be discussed.IntroductionMultiple agencies are involved in global disease surveillance andcoordination of activities is essential to achieve broad public healthimpact. Multiple examples of effective and collaborative initiativesexist. The WHO/AFRO developed Integrated Disease Surveillanceand Response (IDSR) framework, adopted by 43 of the 46 AFROmember states and applied in other WHO regions, was the firstframework designed to strengthen national disease surveillance andresponse systems. The WHO International Health Regulations (IHR)2005 are an agreement between 196 countries to prevent, detectand respond to the international spread of disease. In 2013 CDCworked with Uganda and Vietnam to demonstrate the developmentof surveillance, laboratory, and emergency response center capacityand link data systems for six outbreak prone diseases. More recently,the Global Health Security Agenda (GHSA) was launched with thesupport of 28 countries, WHO, OIE and FAO just as Ebola wasbeginning to emerge in West Africa. This panel brings togetherCDC, local implementing partners, academic technical partners, andinternational non-government donor to discuss current and evolvingstrategies for prevention, detection, and response activities needed forglobal health security.
Post-vaccination rabies sero-survey in Georgia, 2015
Authors: Kartskhia Natia , Ninidze Lena , Avaliani Lasha , Chaligava Tengiz
Published: May 2017

ObjectiveThe objective of this survey was to study vaccination coverage andquality in dogs in Georgia through the detection of post-vaccinationantibodies.IntroductionRabies is endemic in Georgia with up to 100 confirmed cases inanimals per year. There is an estimated 350,000 domestic and straydogs/cats in Georgia. The prophylactic vaccination of domesticanimals against rabies was reestablished in Georgia in 2013. Each yearsince 2013, coverage has increased aiming to cover approximately70% of the total population of dogs/cats in Georgia.MethodsOnly vaccinated dog populations were included in the sero-survey. Using random selection, five locations were selected. Thesurvey was conducted over a period of 4-8 weeks after vaccination.In order to study vaccination coverage, the total dog population wasregistered. Samples were taken only from vaccinated dogs (confirmedby vaccination papers) and samples were sent to the Laboratory ofthe Ministry of Agriculture where they were tested for the presenceof antibodies using ELISA. Epidemiological information and GPScoordinates were recorded in the electronic integrated diseasesurveillance system (EIDSS) and geographic information system(GIS).ResultsOut of 572 dogs in sampled villages, 373 animal’s vaccination wasconfirmed leading to 65% vaccination coverage. Out of 255 samples,241 were suitable for testing; 237 samples (98.3%) were positive forthe existence of antibodies. Antibody titer was not measured.ConclusionsBased on the results of the survey, it can be seen that vaccinationcoverage is generally not high (65%) and needs improvement.The vaccination quality (as determined through the existence ofantibodies) is good (98.3%). In further surveys, antibody titersmust be measured in order to extract more information regardingvaccination quality.
Rates and causes of stillbirth in a demographic surveillance site in Karachi, Pakistan
Authors: Nisar Muhammad Imran , Ilyas Muhammad , Naeem Komal , Fatima Urooj , Shafiq Yasir , Jehan Fyezah
Published: May 2017

ObjectiveTo determine burden, timing and causes of stillbirths in aprospective cohort of pregnant from a low income community settingin peri urban KarachiIntroductionStillbirth remained a neglected issue absent from mention inMillennium Development Goals. An estimated 2.6 million babies arestillborn every year withhighest rate in Pakistan, 43.1 stillbirths/1000births. There is lack of good quality prospective population based datain Pakistanregarding burden, timing and causes of stillbirthsMethodsFrom Jan – Dec 2012, Community Helath Workers (CHWs)identified pregnant women through 3 monthly household visits.Pregnant women were then followed up till end of their pregnancy.In case of a stillbirth, a detailed verbal autopsy (VA) interview wasundertaken 2 weeks after the outcome by a research assistant. VAforms were then reviewed by 2 independent Physicians who assigneda cause for stillbirth. In case of disagreement, VA form was reviewedby a third physician. A consensus between two physicians wasrequired for a definitive cause.ResultsThere were a total of 273 stillbirths (3.04%) reported. Stillbirthrate was 30.7/1000 births. Distribution of antepartum and intrapartumstillbirths was 83% and 17%. Three most common causes of stillbirthsincluded pregnancy induced Hypertension(37%), antepartumhemorrhage (10%) and obstructed labor(6%) (fig. 1).ConclusionsWe have reported a high burden of stillbirths that take placeduring the intrapartum period. This reemphasizes need for goodquality antenatal care in these settings. Appropriate measure needsto be taken targeting most common causes of stillbirths, focusing onimproved antepartum health care facilities