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Detection of Carbon Monoxide Poisoning in Emergency Department
Use of a School Nurse Syndromic Surveillance System during the Novel Influenza A (H1N1) Outbreak in New York City Elisha Wilson, Joseph Egger, Kevin Konty, Marc Paladini, Oxiris Barbot, Don Weiss New York City Department of Health and Mental Hygiene, New York, NY OBJECTIVE Figure 1. FevFlu syndrome and temperature >100.4 oF visits from 1) Describe a near real-time syndromic surveillance the school nurse syndromic surveillance system. system based on visits to the school nurse. FevFlu Syndrome FevFlu Signal Temperature >100.4 Temperature Signal 2) Demonstrate the utility of the school nurse 1400 syndromic surveillance system during the H1N1 1200 outbreak in New York City (NYC), Spring 2009. 1000 BACKGROUND 800 Visits In 2003, NYC implemented a web-based electronic 600 health record system—the Automated Student Health 400 Record (ASHR)—in public elementary and 200 intermediate schools to improve care, to reduce 0 paperwork, and to monitor delivery of healthcare Sep-08 Oct-08 Nov-08 Dec-08 Jan-09 Feb-09Mar-09 Apr-09 May-09 Jun-09 services. The syndromic surveillance program uses data from ASHR to monitor trends in infectious From May 11 to June 19, 2009, 419 schools reported disease syndromes among school children. 8,175 ILI cases to the active surveillance system. For these schools, the percent ILI from active and During the Spring 2009 H1N1 outbreak in NYC, an syndromic surveillance were correlated over time active surveillance program was instituted to monitor (r=0.92, p<0.001), even though syndromic influenza-like illness (ILI) in schools. Once a school surveillance had a significantly lower percent ILI reached a threshold of ILI visits, they were instructed (p<0.001) (Figure 2). This difference may be due to to report cases daily, by telephone. decreased reporting through syndromic surveillance METHODS during the H1N1 outbreak. For syndromic surveillance, school nurses enter chief Figure 2. ILI and absenteeism from the active surveillance and complaint, date, time, school, age, grade, classroom, school nurse syndromic surveillance, during the H1N1 outbreak. and zip code into ASHR. SAS is used to code Active ILI Syndromic ILI Absenteesim complaints into disease syndromes. Temporal trends 0.8% 30.0% are examined by graphs and thresholds are monitored 0.7% 25.0% by cumulative sums (CuSum) analyses. For active 0.6% surveillance, school staff reported an aggregate 0.5% 20.0% % Absent number of ILI cases per school, once a threshold had % ILI 0.4% 15.0% been met. 0.3% 10.0% 0.2% To demonstrate the utility of the school nurse 5.0% 0.1% syndromic surveillance system, we retrospectively 0.0% 0.0% compared this data to data obtained by active 05/11/09 05/18/09 05/25/09 06/01/09 06/08/09 06/15/09 surveillance data. Data were matched by school and date. ILI was defined as temperature of >100.4 oF CONCLUSIONS and either cough or sore throat. Percent ILI was The school nurse syndromic surveillance system uses calculated using enrollment data. existing data from electronic student health records. RESULTS Activity correlated well with an active surveillance During the 2008-2009 school year, 1,192 schools system established during a large citywide epidemic. reported approximately 1.6 million school nurse Improvements to the syndromic surveillance system visits via syndromic surveillance. The daily number and further integration of multiple data sources, of visits with chief complaints of fever or achiness including school absenteeism data are underway. (FevFlu syndrome) and visits with temperature REFERENCES >100.4 oF were correlated over time (r=0.97, Besculides M, Heffernan R, Mostashari F, Weiss D. p<0.001) and showed similar daily CuSum signals Evaluation of school absenteeism data for early (Figure 1). outbreak detection, New York City. BMC Public Health. 2005;5:105.
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