Transcript Experiences in the Use of Non-Traditional Data Sources in

Experiences in the Use of
Non-Traditional Data
Sources in a Rural State –
South Carolina
Dan Drociuk, MT(ASCP), MSPH – Director
Epidemiological Response / Enhanced Surveillance Section
Division of Acute Disease Epidemiology
South Carolina Department of Health and Environmental Control
Outline

Part I:
• The “People”


How we are organized to develop, implement, monitor and
respond to EED system needs.
Part II:
• The “Push”


How we disseminate information about EED systems and
general epidemiological activities.
Part III:
• The “Products”

Case studies showing the interaction and intersection of EED
systems currently in use in South Carolina.
Part I:
The “People”
A bit about South Carolina…

Approximate population: 4,350,500 (sans golf
courses and beaches…)
• Three MSA’s in the “Top 100”:

Columbia, Charleston, Rock Hill/Charlotte
• Tourism a main industry along the costal areas

Centralized health department structure
• All public health employees are state employees
regardless of location
• No local boards of health
Current Systems in Use






Palmetto Poison Center (electronic daily feeds to public
health),
National Retail Data Monitoring (NRDM) for OTC sales
(using “home-grown” C1, C2, C3 indicators),
BioSense for DoD and VA ambulatory care procedures
and ambulatory care diagnosis,
Essence data monitored and “crossed” with Biosense
alerts and indicators.
Sentinel providers with Influenza-like Illness reporting
(number/wk).
Two (2) pilot hospitals providing chief-complaint data in
“home-grown” categories.
DIVISION OF ACUTE DISEASE EPIDEMIOLOGY
Dixie F. Roberts, MPH, BSN, RN
Division Director
Tuesday, July 5, 2005
Information Technolocy
Section
Jason Collins
Section Director
Reportable Disease
Surveillance Section
Libby Greene
Section Director
Acute Disease Response/
Enchanced Surveillance
Section
Dan Drociuk
Section Director
DADE Program Areas
Dixie Roberts
Administrative Support
Team Section
Gloria McCurry
Administrative Coordinator
Program Area Staff:
-Dr. Tom Fabian, BT/ HRSA
Medical Director
IT Staff:
Mark Rahn
Vacant
Vacant
HAN, etc:
Jamey Rudisell
Shana LeGrand
Surveillance Staff:
Claire Youngblood
Ted LeBlanc
Suzy Wesley
All DADE staff & teams
accountable to Section Director
for assigned routine Surveillance
Activities
Dr. Eric Brenner, Medical
Epidemiologist
Response Staff:
Julie Schlegel, Foodborne Epi
Coordinator
Michelle Myer, BT Epi and
Response
*Amy Belflower, QA Coordinator
Marya Barker
Dr. Lena Bretous, Medical
Epidemiologist
Dr. Shirley Jankelevich,
Medical Epidemiologist
Dr. Mary Anne Wenck
EIS Officer
Dr. Marcia Headrick, Public
Health Veterinarian
Vacant, Careful Antibiotic Use
Nurse Educator
Administrative Support Team:
Rosa Wesley
Phillipine Outing
Suzy Wesley
DIVISION OF ACUTE DISEASE EPIDEMIOLOGY
Dixie F. Roberts, MPH, BSN, RN
Division Director
Tuesday, July 5, 2005
Information Technolocy
Section
Jason Collins
Section Director
Reportable Disease
Surveillance Section
Libby Greene
Section Director
Acute Disease Response/
Enchanced Surveillance
Section
Dan Drociuk
Section Director
DADE Program Areas
Dixie Roberts
Administrative Support
Team Section
Gloria McCurry
Functions
Functions
Acute Response:
· Liasion with Regional Health
Departments regarding
epidemiological capacity/response.
Functions
Carolina Health Electronic Surveillance
System: (CHESS)
Develop/ operate/ maintain NEDSS based
electronic surveillance system (CHESS)
Functions
· Reportable Disease Case &
Outbreak Investigations/
Coordination
CHESS: Surveillance Data Entry and
Notifications, Data Reports, &
Dissemination
· Policies & Procedures
· CHESS Data Collection
Coordinate with Surveillance Section on
CHESS implementation.
· Coordinate Data Analysis &
Interpretation
-Develop/ operate/ maintain CHESSImmunization Registry
Coordinate with Immunization Division on
CHESS-IR
· Policies/Procedures
-Health Alert Network
Develop and maintain capacity for rapid
Public Health Emergency notification
system
PHIN Standards: monitor quality assurance
and PHIN compliance measures
Coordinate with Bureau of Information
Systems and Health Services Information
Systems to assure compliance with Agency
standards.
· Data Quality Assurance
· Responsible for:
· List of Reportable Conditions
· School and Childcare Exclusion
List
· Annual Report
· Epi Notes
· Request for Data
· Web site
· CHESS Training
· Epi Records/Documentation
· Public Health Preparedness
Incident Command System
· DADE SOP & Implementation
· Bureau of Disease Control
SOP & implementation
· HAN notification coordination
· On-Call System: Routine Work
Day & 24/7
· Answering Service
· Epidemiological Response
Quality Assurance
Enhanced Surveillance:
· Palmetto Poison Center data
analysis
· Early Aberration Reporting
System
· Syndromic Surveillance pilot
projects
· Hospital Discharge data
analysis
Functions
Accountable for program outcomes/
performance measures, grant and
program budget writing, and
integration of activities into the
Surveillance and Response
processes in the Division.
Program Area assignments are not
intended to restrict involvement across
the DADE Sections (functional units).
BT-CDC – Dan Drociuk
NEDSS-IT (Vacant)
Surveillance Sections – Libby Greene
HAN-IT – Jamey Rudisell
Agroterrorism & Zoonotic Disease Dr. Marcia Headrick
BT-HRSA
Dr. Tom Fabian
ELC
Antibiotic Resistance – Vacant
(Dixie Roberts)
Hepatitis – Libby Greene
Influenza – Dr. Lena Bretous
WNV &Vector Borne Disease Dr. Lena Bretous
NEDSS-IT (Vacant) & Surveillance
Sections – Libby Greene
Foodborne Disease – Julie Schlegel
Vaccine Preventable Diseases Dr. Shirley Jankelevich
Childcare and School Health Michellle Myer
Coordinator:
· Admin. Supervision
· Procurement
· Personnel Items
· Inventory
· Network/Telephone/Space
Coordination
· Epi Notes
· On Call Schedule
Admin. Team:
· Telephone Coverage
· Mail
· Travel Arrangements &
Reimbursements
· Minutes
· DHEC Forms
· Meeting/Conference/Training
Preparation
· Data Surveillance Activities
· Data Entry
· Copier Maintenance & Paper
· Fax Machine Maintenance &
Paper
· Network Printer Maintenance
· TRAMS
· DHEC 1129 Cards/Case
Report Letters
· Mailouts
· Scheduling of Conference
Rooms
· Epi Team Database’s
Regional Epi Teams


Services are delivered and surveillance happens
at the local/community level
Surveillance, case and outbreak investigation &
response starts with the Regional Epi Team
• 6-20 members
• Mix of skills: nurses, Env. Health, PIO
• Established 1995 to provide trained integrated teambased response to routine surveillance, case
investigations, and outbreak investigations

Available for Urgent Reports 24/7 via on-call
rotation.
Epidemiological Responses to Events of
Public Health Significance

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“White powder events”
Ricin in a U.S. Postal Facility in Greenville
Chlorine tanker train derailment, Graniteville, SC
Numerous point-source outbreak investigations
• Food-borne (Salmonella’s),
• Water-borne (Legionella cluster, rash-illness),
• Respiratory (Pertussis)

Hurricane Katrina Evacuation Center surveillance
activities, Greenville, SC
Part II:
The “Push”
Dissemination of Epi-related
information

Daily
• Provided to the South Carolina Intelligence Fusion Center
• Reports from our Division of Acute Disease Epidemiology on-call staff
for overnight calls received,
• Summary information from our Early Event Detection Systems
(BioSense, OTC sales, Palmetto Poison Center)
• Previous day on-call events of public health significance

Weekly
• Provided via the Epidemiological Weekly Report (EWR)
• Summary information from our Regional and Central Office

Monthly
• Meetings with Regional Epidemiology Response Staff

As Needed
• Distribution via the SC Health Alert Network
• CDC and DHEC Health Alerts/Advisories/Updates
Example of a Daily SCIEx report
Example of a weekly EWR
EWR: Epidemiological Weekly Report

The EWR is compiled weekly from
Regional and DADE reports.
• It includes basic summary information related
to an ongoing or concluding epiinvestigations.
• Submissions usually include what is known or
hypothesized about etiology, geographic
location, and numbers of persons affected.
EWR: Epidemiological Weekly Report

Circulation:
• The EWR is submitted to the Deputy
Commissioner for Health Services, members
of the Senior Leadership Team, Central and
Regional Office Leadership, the Office of
Public Health Preparedness, etc.

Goal:
• Provide situational awareness regarding Epi
activities across the state.
EWR: Epidemiological Weekly Report

Statistics:
• In 2005, EWR’s documented 288 “new investigations” of
potential outbreaks or single cases of disease or events of public
health significance.
• In 2005 documented outbreaks totaled 62 stratified as follows
(by modes of transmission):

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
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Respiratory
Foodborne
Unknown
Person-to-person
Fecal-oral
Contact
Nosocomial
20
16
11
7
5
2
1
(32%)
(26%)
(18%)
(11%)
( 8%)
( 3%)
( 2%)
2004-2005 SC Foodborne
Outbreak Statistics
2004
2005
13
16
% Agent Identified
92%
79%
% Source Identified
46%
29%
# FB Outbreaks
Part III:
The “Products”
Case Study 1:
Chlorine Release in
Graniteville, South Carolina
What Happened?



At 2:39 AM, a 42-car Norfolk and
Southern train derailed
A tanker car containing chlorine was
punctured, releasing approximately 60
tons of chlorine
The chlorine was released in the
immediate vicinity of Avondale Mills, the
commercial district, and residential
areas of Graniteville SC
Objectives of a Rapid
Epidemiological Assessement

Assess
•
•
•
•
•
•
Extent of exposure
Morbidity
Health services used
Identify persons at risk for long-term sequelae
Risk factors for severe outcomes
Location of exposure
Case Definition

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Person treated for symptoms or
complications from chlorine exposure
Identified by
• Hospital emergency department logs
• Physician reporting
Emergency Department Visits
within 24 Hours
Facility
ED Visits, N=272 (%)
Aiken Regional Medical Center
108
(39.7)
Other SC hospitals
10
(3.7)
Augusta, GA hospitals
154
(56.6)
Signs or Symptoms Reported
Symptom (N=290)
Coughing
Eye burning
Shortness of breath
Headache
Chest pain
Nausea
Nose burning
"Cough up phlegm"
Choking
Dizziness
Vomiting
% Reporting
82
77
74
63
59
53
51
50
46
42
34
Deaths, Hospitalizations, and Emergency Department Visits
Following Train Derailment, Graniteville, SC - 2005
280
260
ED Visit, Not Admitted
Admitted to Hospital
Deceased, at Site of Accident
100
Number
80
of
Events
60
40
20
0
1
3
5
7
9
11
13
15
17
Day(s) Since Accident
19
21
23
25
Hospitals that Treated Patients for Chlorine Exposure –
January 6-7, 2005
40
Barnwell
Edgefield
Lexington
St. Josephs
Doctors
MCG
University
Aiken
35
30
25
Number
20
of
Patients
15
10
5
0
Time
Situational Awareness Issues

Healthcare providers are going to treat people
first, and worry about the “coding” later
• Review of charts showed a broad span of chief
complaints (n=81), primary diagnosis (n=48) and
ICD-9 codes (n=51) used.

Data used for situational awareness, many are
going to be relying upon the data to make
decisions. This is a “paradigm shift” beyond
being simple early event detection system.
Opportunities


Use of Early Event Detection systems for monitoring an
emerging event must be flexible and sensitive to be able
to answer the questions being asked, an EED must have
the flexibility to allow local users to create ad hoc
syndrome categories.
The wealth of information present via an electronic
medical record only tells part of the story. The ability to
identify the needs of the people impacted greatly
contributes to the overall situational awareness of an
emerging event.
Next Steps


Within the 3-digit ZIP code area (ZIP3) 298 that
surrounds Graniteville, BioSense identified a
data anomaly based on the graphical
visualization in the Respiratory syndrome
category that corresponded to day 2 of the
exposure.
However this anomaly was only apparent for 1
day (1/7/05) and the source of this anomaly has
not been validated to determine both the source
of this anomaly and its relationship to chlorine
toxicity.
Case Study 2:
Use of Poison Control
Center data
Palmetto Poison Center
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1-800-222-1222
Located in Columbia, SC
Serves the entire state of South Carolina
Staff consists of pharmacists
and nurses
Medical Director is trained in toxicology
and emergency medicine
Palmetto Poison Center

Services Provided
• 24 hours/7 days a week
• Phone service to provide poison treatment
information

For the public and health care professionals
• Information requests

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Medications
Pesticides
Plants
Food poisoning
Chemicals
Statistics

South Carolina
• 2005: Over 37,000 calls to the Center



74% of total calls involved human poison
exposures
30% involved adults over 21yo
80% managed by Poison Center without further
medical evaluation needed
Documentation

Every incoming call documented
• Follow up calls included


Record includes name, phone number and zip code of
caller
Patient data:
•
•
•
•
•
•
•
Age, gender weight
Exposure substance, route and amount
Reason for exposure
Time of exposure
Symptoms
Treatment provided
Outcome
State Surveillance - DHEC Notification

Require notification of Public Health for:
• Potential food poisoning/food tampering
cases
• Occupational pesticide exposures
• Questionable exposure to current public
health concerns, i.e. anthrax (‘suspicious
powder calls’), West Nile Virus, chlorine
toxicity
• Animal bites
State Surveillance - DHEC Notification

Currently faxing cases and providing
downloads of toxidromes every 24hrs into
Toxitrak
• Case information from Poison Center is
included in the upload
• Reports can be generated

Ex. How many cases had vomiting, diarrhea, fever
in Clarendon county in the last 4 weeks; number of
suspected food poisoning cases from restaurants
per county, city or zip code
The “Epi” of Poisonings in SC

Who?
• 62% of calls involve children <5

Where and When?



92% of all accidental exposures occur in the home
0.8% at school
Early evening at meal time most likely, followed by
late morning.
The “Epi” of Poisonings in SC
What?
38.8%
9.0%
9.1%
9.1%
8.5%
4.5%
Prescription and OTC medications,
e.g. analgesics, cough/cold
Household cleaning substances
Cosmetics and personal care products
Plants
Insecticides, herbicides, rodenticides
Bites/envenomations
Case Study 3:
Parris Island, South
Carolina – “Respiratory”
Sentinel Alerts
Disease Surveillance at Marine Corps Recruit Depot
(MCRD), Parris Island



Marine Corps Recruit Depot, Parris Island
Marine Corps Air Station, Beaufort SC
Naval Hospital, Beaufort SC
Personnel Assigned to NHB 728
Officers - 113
Enlisted - 330
Civilian - 263
MC - 30
NC - 45
Recruit Training Regiment
Within 1st, 2nd, and 3rd Battalions, there are four
companies. Each company contains an average of six
platoons with 60 to 80 recruits in each.
360 – 480 per company.
1440 – 1920 per Battalion.
Within 4th Battalion (350-400), there are three
companies, N, O, and P. Each company contains an
average of two platoons with 50 to 60 recruits in each.
Fourth Battalion trains only female recruits.
Beaufort Naval Hospital
Provides general medical services to all Active Duty Navy and Marine
Corps Personnel, as well as Retired military personnel and all military
dependents residing in the Beaufort area, a total population of
approximately 30,000 beneficiaries.
Officers – 28
Enlisted – 158
Civilians – 22
Total
208
Hospital
Director Clinical
Support Services
Branch Health Clinic, MCAS
Branch Health Clinic, MCRD
Parris Island
1st BAS
Director Clinical
Support Services
2nd BAS
3rd BAS
Preventive Medicine
4th BAS
Methods of Disease Detection

Traditional reportable disease surveillance
• State processes.
• Navy Disease Reporting System (NDRS)

Sentinel Surveillance
• Naval Health Research Center’s FRI surveillance at
recruit training centers

Astute clinicians

Syndromic surveillance
• ESSENCE IV
14 admissions to BMH in
September and October 2005

2 from 1st Battalion
• Charlie company – 2

7 from 2nd Battalion
• Foxtrot company - 3
• Gulf company – 4

5 from 3rd Battalion
• Lima company - 2
• Kilo company – 3
Recruit Admission to Beaufort Naval Hospital
and Beaufort Memorial Hospital for Pneumonia
2005
30
25
Beaufort Naval (BNH)
20
15
Beaufort Memorial
(BMH)
10
5
Ja
nu
Fe a ry
br
ua
ry
M
ar
ch
Ap
ril
M
ay
Ju
ne
Ju
A u ly
Se gu
pt st
em
b
O er
ct
ob
er
0
Patients are admitted to BMH when a chest tube is needed
MCRD Parris Island, Data from ESSENCE
500
450
400
Visits/Week for
Respirtatory Complaints
Medical Visits/Week for
Pneumonia NOS
# of Patients with
Pneumonia NOS
Positive GABS throat
cultures/wk
300
250
200
150
100
50
10/2/2005
9/18/2005
9/4/2005
8/21/2005
8/7/2005
7/24/2005
0
7/10/2005
Patients
350
10/2/2005
9/25/2005
9/18/2005
9/11/2005
9/4/2005
8/28/2005
8/21/2005
8/14/2005
8/7/2005
7/31/2005
7/24/2005
7/17/2005
7/10/2005
Weekly Penumonia visits: MCRD Parris Island. Data From
ESSENCE
300
250
200
150
100
50
0
10/9/2005
9/25/2005
9/11/2005
8/28/2005
8/14/2005
7/31/2005
7/17/2005
7/3/2005
6/19/2005
6/5/2005
5/22/2005
5/8/2005
4/24/2005
4/10/2005
MCRD Pneumonia visits (all types) weekly incidence for every
100 Recruits
3
2.5
2
1.5
Series1
1
0.5
0
-0.2
12/2/2005
11/2/2005
10/2/2005
9/2/2005
8/2/2005
7/2/2005
6/2/2005
5/2/2005
4/2/2005
3/2/2005
2/2/2005
1/2/2005
Weekly incidence of positive GABS cultures MCRD PI
1.2
1
0.8
0.6
GABS +
0.4
0.2
0
Why the rise?
Why the rise? We considered:


Crowed Living Conditions.
Poor hygiene?
• Always a struggle, but the Marine leadership is
more cooperative than ever in this area.
• Random interviews of recruits in the clinic indicate
that they have been properly instructed re: hand
hygiene.

Recruits presenting too late?
• Interviews of the admitted recruits indicate that
they were encouraged vs. discouraged to seek
medical care early.
Why the rise? We considered

Something in the buildings?
• Mold and moisture is a problem in some buildings aboard
MCRD PI. Toxic mold was discovered in one building where
all recruits are massed together for training.


Slow recognition of cases by providers?
• Some recruits admitted to BMH have been ill with
respiratory symptoms for 3-4 weeks prior to
admission, and they had been seen in “medical”
two or more times prior to admission.
Too high a turnover in medical staff to ensure
effective leadership and staff competency?
• 3 SMOs in last 4 months
• Nearly 100% turnover of BAS staff in Sept-Oct.
Lab Results


Nine of the 17 admission to BMH have
grown GABS from pleural fluid, including 5
out of last 6 admitted in October.
Nothing atypical about resistance patterns
Actions Taken


Chemo prophylaxis with Bicillin provided to
all recruits in high incident Companies, to
their DI’s and to their medical staff (BAS).
Presented data to MCRD Providers
12/26/2005
10/26/2005
8/26/2005
6/26/2005
4/26/2005
2/26/2005
12/26/2004
10/26/2004
8/26/2004
6/26/2004
4/26/2004
2/26/2004
12/26/2003
10/26/2003
1/16/2006
11/16/2005
9/16/2005
7/16/2005
5/16/2005
3/16/2005
1/16/2005
11/16/2004
9/16/2004
7/16/2004
5/16/2004
3/16/2004
1/16/2004
11/16/2003
9/16/2003
7/16/2003
5/16/2003
3/16/2003
1/16/2003
11/16/2002
Pneumonia Visits 7-day Moving Avg.
60
50
40
30
Series1
20
10
0
MCRD Recruit Population
8000
7000
6000
5000
4000
3000
2000
1000
0
Series1
Early Event Detection:
Over-the-Counter Drug Sales

In South Carolina as of February 2006:
• 536 distinct sources are represented in the data


Which is approx 2.6% of the National data sources
Possible Uses for OTC Sales Data:
• If OTC sales data indicate an increase in use of antidiarrheals, this could point to a foodborne outbreak.
• An increase in the use of cold/flu remedies might give
information on severity of the influenza season or an
acute respiratory event (i.e. release of chlorine).
Date/Day
Zip Code
City
County
Number of Stores (zip)
Standard Deviation
Raw Count
18-Dec-05
29657
Pickens
Pickens
1
4.49
2
Sunday
29696
West Union
Oconee
1
4.62
6
Stores (by zip
code)
% of stores
represented
Count (by zip
code)
% of count
represented
Date/D
ay
County
Stores
(county)
w/ > 3 SD
indicator
by zip code w/
aberration
Count
(county)
w/ > 3 SD
indicator
by zip code w/
aberration
18-Dec05
Pickens
12
1
8%
7
2
29%
Sunday
Oconee
5
1
20%
6
6
100%
Date/Day
Zip Code
City
County
Number of Stores (zip)
Standard Deviation
Raw Count
19-Dec-05
n/a
n/a
n/a
n/a
n/a
n/a
Monday
Stores (by zip
code)
% of stores
represented
Count (by zip
code)
% of count
represented
Date/
Day
County
Stores
(county)
w/ > 3 SD
indicator
by zip code w/
aberration
Count
(county)
w/ > 3 SD
indicator
by zip code w/
aberration
19-Dec05
n/a
n/a
n/a
n/a
n/a
n/a
n/a
Monday
Date/Day
Zip Code
City
County
Number of Stores (zip)
Standard Deviation
Raw Count
20-Dec-05
29601
Greenville
Greenville
2
24.75
3
Tuesday
29356
Landrum
Spartanburg
2
3.01
6
29654
Honea Path
Anderson
2
3.01
4
29669
Pelzer
Anderson
2
3.21
7
Stores (by
zip code)
% of stores
represented
Count (by zip
code)
% of count
represented
Date/
Day
County
Stores
(county)
w/ > 3 SD
indicator
by zip code w/
aberration
Count
(county)
w/ > 3 SD
indicator
by zip code w/
aberration
20-Dec05
Greenville
69
2
3%
88
3
3%
Tuesday
Spartanburg
30
2
7%
37
6
16%
Anderson
21
4
19%
35
11
31%
Date/Day
Zip Code
City
County
Number of Stores (zip)
Standard Deviation
Raw Count
21-Dec-05
n/a
n/a
n/a
n/a
n/a
n/a
Wednesday
Stores (by zip
code)
% of stores
represented
Count (by zip
code)
% of count
represented
Date/Day
County
Stores
(county)
w/ > 3 SD
indicator
by zip code w/
aberration
Count
(county)
w/ > 3 SD
indicator
by zip code w/
aberration
21-Dec-05
n/a
n/a
n/a
n/a
n/a
n/a
n/a
Wednesday
Date/Day
Zip Code
City
County
Number of Stores (zip)
Standard Deviation
Raw Count
22-Dec-05
29669
Pelzer
Anderson
2
3.14
7
Thursday
Stores (by zip
code)
% of stores
represented
Count (by zip
code)
% of count
represented
Date/ Day
County
Stores
(county)
w/ > 3 SD
indicator
by zip code w/
aberration
Count
(county)
w/ > 3 SD
indicator
by zip code w/
aberration
22-Dec05
Anderso
n
21
2
10%
28
7
25%
Thursday
Date/Day
Zip Code
City
County
Number of Stores (zip)
Standard Deviation
Raw Count
23-Dec-05
29601
Greenville
Greenville
2
19.92
4
Friday
29611
Greenville
Greenville
6
3.65
8
29690
Traveler's Rest
Greenville
2
4.27
10
Stores (by zip
code)
% of stores
represented
Count (by zip
code)
% of count
represented
Date/
Day
County
Stores
(county)
w/ > 3 SD
indicator
by zip code w/
aberration
Count
(county)
w/ > 3 SD
indicator
by zip code w/
aberration
23-Dec05
Greenville
69
8
12%
105
22
21%
Friday
Date/Day
Zip Code
City
County
Number of Stores (zip)
Standard Deviation
Raw Count
24-Dec-05
29605
Greenville
Greenville
6
3.02
16
Saturday
29680
Simpsonville
Greenville
4
4.39
16
29303
Spartanburg
Spartanburg
4
3.22
6
Stores (by zip
code)
% of stores
represented
Count (by zip
code)
% of count
represented
Date/
Day
County
Stores
(county)
w/ > 3 SD
indicator
by zip code w/
aberration
Count
(county)
w/ > 3 SD
indicator
by zip code w/
aberration
24-Dec05
Greenville
69
10
14%
138
32
23%
Saturday
Spartanburg
30
4
13%
52
6
12%
Date/Day
Zip Code
City
County
Number of Stores (zip)
Standard Deviation
Raw Count
25-Dec-05
29611
Greenville
Greenville
6
3.33
5
Sunday
Stores (by zip
code)
% of stores
represented
Count (by zip
code)
% of count
represented
Date/
Day
County
Stores
(county)
w/ > 3 SD
indicator
by zip code w/
aberration
Count
(county)
w/ > 3 SD
indicator
by zip code w/
aberration
25-Dec05
Greenville
69
6
9%
63
5
8%
Sunday
Date/Day
Zip Code
City
County
Number of Stores (zip)
Standard Deviation
Raw Count
26-Dec-05
n/a
n/a
n/a
n/a
n/a
n/a
Monday
Stores (by zip
code)
% of stores
represented
Count (by zip
code)
% of count
represented
Date/
Day
County
Stores
(county)
w/ > 3 SD
indicator
by zip code w/
aberration
Count
(county)
w/ > 3 SD
indicator
by zip code w/
aberration
26-Dec05
n/a
n/a
n/a
n/a
n/a
n/a
n/a
Monday
Next Steps

Currently engaged in retrospective studies
for all documented outbreaks from 2005,
by mode of transmission, to determine if
an temporal association can be made and
at what level.
Bottom-line

“Syndromic surveillance is another “arrow
in our quiver” of ways to detect and
respond to both our routine outbreaks of
public health significance and also those
large-scale events that will require
exceedingly complex reporting and
situational awareness requirements”.
Acknowledgements
SC DHEC






Amy Belflower
Claire Youngblood
Marya Barker
Amy Roach
Michelle Myer
Mary Anne Wenck, EIS Officer
Marine Corps Recruit Depot
(MCRD), Parris Island
• LT Allen D. Wright,
Preventive Medicine
Department, Naval Hospital
Beaufort
CDC
Palmetto Poison Center


Jill Michaels, PharmD
William Richardson, MD



Leslie Z Sokolow
Roseanne English
Haobo Ma
Questions?