Data for Biosurveillance: A tutorial. Main Point. The range of data being collected for public health surveillance have expanded considerably. ANIMALS. HUMAN BEHAVIORS. NON TRADITIONAL USES. CLINICAL DATA. Biosurveillance Data Space. LATER DETECTION. EARLY DETECTION.
The range of data being collected for public health surveillance have expanded considerably
NON TRADITIONAL USES
CLINICAL DATABiosurveillance Data Space
direct. Cloud cover
Sensitivity 0.43 Specificity >95%
Small sample 1/1 detected, 1 false alarm
Similar results to Espino
Also needed for Web or call center queries, and radiographs
OutputCoCo Naive Bayesian Parser
Maps free-text chief complaint to one of seven prodrome categories (or an eighth category—none)
P(GI|NVD) = .9
CoCo Naive BayesClassifier
Sensitivity, specificity and likelihood ratio positive (LR+) measurements for the CoCo
classifier using the Utah Department of Health emergency department gold standard.
Respiratory infection with fever*
Gastroenteritis without blood
Meningitis / encephalitis
Febrile illness with rash*
*Required documentation of fever in the patient record.Accuracy of Case Detection: CoCo Naïve Bayes vs. UDOH Manual ED log review
Courtesy Per Gesteland, MD
Hospital P&I Diagnoses
SDs from Mean
Ivanov and Gesteland
Detecting Respiratory Outbreaks in Children by monitoring Chief Complaints
Detection from CCs precede that from admissions by 9 days
(95% CI -5-23)
kids respiratory (lower respiratory infections):
Detection from CCs precede that from admissions by 23 days
(95% CI 12-33)
(Ivanov, Wagner, Chapman)
WHICH IS BETTER, ICD-9 or FREE TEXT? At detecting Acute Lower Respiratory Illness from Chief Complaints
(Espino, Wagner, Dowling, Chapman)
Summary of clinical data by clinical systems and market penetration (estimated)
Legend: ED, emergency department; LTCF, long term care facility; -, not applicable; ?, unknown
Numbers in parenthesis are the number of UPC codes in the category
*Stirling R, Aramini J, Ellis A, et al. Waterborne cryptosporidiosis outbreak, North Battleford, Saskatchewan, Spring 2001. Can Commun Dis Rep. Nov 15 2001;27(22):185-192.
… Precautionary water advisory issued on 4/26
Detectable peak on 4/2 in sales of over-the-counter antidiarrheals
*Rodman JS et al. Pharmaceutical sales: A method of disease surveillance. Journal of Environmental Health, Nov 1997:8-14.
**Proctor et al. Surveillance data for waterborne illness detection: an assessment following a massive waterborne outbreak of Cryptosporidium infection. Epidemiol Infect. 1998;120(1):43-54.
26-fold increase in sales in Feb
Outbreak detected March 5
Rodman JS et al. Pharmaceutical sales: A method of disease surveillance. Journal of Environmental Health, Nov 1997:8-14.
3X increase in sales in
Public health awareness April 5, 1993
Proctor et al. Surveillance data for waterborne illness detection: an assessment following a massive waterborne outbreak of Cryptosporidium infection. Epidemiol Infect. 1998;120(1):43-54.
Hogan et al. Detection of Pediatric Respiratory and Diarrheal Outbreaks from Sales of Over-the-counter Electrolyte Products. J Am Med Inform Assoc, 10(6) November 2003
SALT LAKE CITY, UTAH
INDIANAPOLIS, INDetecting Pediatric Diarrheal and Respiratory Outbreak from Sales of Pediatric Electrolytes
Data courtesy IRI, Utah DOH, Indianapolis Network for Patient Care, and PA HC4 Council
Welliver RC, Cherry JD, Boyer KM, et al. Sales of nonprescription cold remedies: a unique method of influenza surveillance. Pediatr Res. Sep 1979;13(9):1015-1017.
Yes, but they sometimes miss outbreaks or detect them late
Yes, but maybe the data are inherently late. Plus there is still the problem of undetected outbreaks
Also, there may just be a better way. There may be highly useful data that they just do not have the infrastructure to collect
Being done in scores of jurisdictions
Being done in Taiwan
Being done in 46 states and Puerto Rico
Being done in China
Zeng, Wagner et al. JAMIA 2002.
See bibliography that will be on Web at www.health.pitt.edu/rods