Rapidly Adapting Flexible Surveillance Systems for Emergent Event Response
Authors: Edison Laura , Soetebier Karl , Dishman Hope , Smith Wendy , Cowell Alex , Drenzek Cherie 
Published: May 2017

ObjectiveTo describe how flexible surveillance systems can be rapidlyadapted and deployed, and increase the efficiency and accuracy ofsurveillance, during responses to outbreaks and all hazard emergentevents.IntroductionGeorgia Department of Public Health (DPH) epidemiologists haveresponded to multiple emergent outbreaks with diverse surveillanceneeds. During the 2009 H1N1 influenza response, it was necessaryto electronically integrate multiple reporting sources and viewpopulation-level data, while during the 2014–2015 West African Ebolaepidemic, it was necessary to easily collect and view individual leveldata from travelers to facilitate early detection of potential importedEbola disease. DPH in-house information technology (IT) staffwork closely with epidemiologists to understand and accommodatesurveillance needs. Through this collaboration, IT created a robustelectronic surveillance and outbreak management system (OMS) toaccommodate routine reporting of notifiable diseases and outbreakinvestigations, and surveillance during emergent events.MethodsOMS was created within the State Electronic Notifiable DiseaseSurveillance System (SendSS); a secure, HIPAA-compliant, Oracleand web-based platform which collects data on all notifiable diseasesin Georgia. This flexible platform has multi-functionality includingdynamic web-based surveys that link to case records or outbreaks,online case reporting, electronic laboratory reporting, contact tracing,visual dashboards summarizing outbreak data, electronic alerts, andindividual accounts for users with varying privileges to limit access tospecific modules. These features can be customized for any emergentevent.ResultsSendSS and OMS are widely used by state and districtepidemiologists. Individual case and outbreak management activitiesinclude but are not limited to: notifiable disease and conditioncases; all disease clusters; animal bites surveillance including biteinvestigation and laboratory results; and syndromic surveillance dataautomatically collected from 90 emergency facilities. OMS has beenrapidly modified to facilitate efficient epidemiologic responses toemergent events such as: integrating multiple reporting sources duringthe H1N1 outbreak; shelter surveillance during hurricanes Katrinaand Rita in 2005; active monitoring of >2,500 travelers in Georgiaduring the Ebola response; tracking cases investigations during theZika response, and future monitoring of poultry workers if highly-pathogenic avian influenza occurs in Georgia.ConclusionsThe flexible and customizable features of SendSS and OMSaccommodate the changing needs of epidemiologists to monitora variety of diseases. Rapid implementation has enabled DPHepidemiologists to respond efficiently to emergent events usinglimited human resources, achieving immediate situational awarenessby incorporating multiple data sources into user friendly dashboardsand notifications, and easily sharing information among state andfederal stakeholders to facilitate rapid risk assessment and response asneeded. The success of these systems illustrates the return on DPH’spreparedness investment in retaining technical staff to work withepidemiologists to meet urgent surveillance needs.