Update to 2010 State Influenza Coordinator’s ConferenceSession Two – New and Enhanced SurveillanceSunday June 6, 2010 - 3:00-3:15pm, Portland, OR

Distribute Project

Division of Healthcare Information (DHI) (proposed)Public Health Surveillance Program Office (proposed)Office of Surveillance, Epidemiology, & Laboratory Services (OSELS) (Proposed)Centers for Disease Control & Prevention (CDC)

Taha A. Kass-Hout, MD, MSDeputy Director for Information Science (Acting)

Disclaimer: The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of The Centers for Disease Control and Prevention.

Principles & Characteristics• Aggregates counts of ILI and total ED

visits from existing health dept ED-SS systems– Cross-tabulated by a limited number of

variables

• Allows flexibility in use of “chief complaint” (or ICD9) ILI Syndromic criteria that HDs had already developed

• Fosters “community of users”

A Brief History of Distribute• Proof-of-concept Phase (2006 to July 2009)

– Funding from CDC and Markle Foundation– Recruited nine sites in US and three internationally– Focused on establishing viability of approach

• Pandemic Phase (August 2009 to June 2010)– Expanded funding from CDC lead to CDC, PHII and

ISDS collaboration– Expanded from 10 to 34 sites (including 10

BioSense sites) in ~4months– Enhanced information systems, analyses– Strengthened community support

Current Status• ED Coverage Estimates

– 34 Health departments (~1,300 EDs) with 8 HDs ≥ 90% ED visit coverage

• Local ILI Syndrome Definitions– Narrow: attempts to replicate ILINet

definition, may exclude many with influenza due to brevity of CC recording

– Broad: less restrictive, yields parallel, higher amplitude signal

Current Jurisdictions

Information Pathways

Hospitals HD SS system

Hospitals HD SS system CDC BioSense*

Hospitals HD SS system

Hospitals CDC BioSense*Hospitals

* With HD approval

Via ISDS (UW)

Hospitals HD SS systemHospitals HD SS system Via CDC

Stratifying Variables

Temperature Disposition Age

6 8

34Number of Jurisdictions

Disposition (Admission) of ILI Pts

4/1

4/11

4/21 5/

15/

115/

215/

316/

106/

206/

307/

107/

207/

30 8/9

8/19

8/29 9/

89/

189/

2810

/810

/18

10/2

811

/711

/17

11/2

712

/712

/17

12/2

71/

61/

161/

26 2/5

2/15

2/25 3/

73/

173/

27 4/6

4/16

4/26 5/

65/

16

02468

1012141618

% o

f ILI

pat

ient

s ho

spita

lized

% o

f ED

vis

its b

y IL

I pat

ient

s w

ho w

ere

hosp

italiz

ed

% o

f ED

vis

its b

y IL

I pat

ient

sno

t hos

pita

lized

Week Ending

Yellow: ILI patients hospitalized ILI patients 

Red: ILI patients hospitalized Total ED patients Green: ILI patients non-hospitalized Total ED patients

Source: BioSense

Public Site

Restricted(Contributor’s) Site

Online Data

http://ISDSDistribute.org

Comparison to ILINet• State-based

jurisdictions– Correlations ranged from

0.64 to 0.96 with mean and median of 0.83 and 0.83, respectively

• Local-based jurisdictions– Correlations ranged from

0.38 to 0.91 with mean and median of 0.76 and 0.81, respectively

• Visually, major peaks in % ILI in the 2 systems tracked well together

Community of Practice• Approximately 90 state and local

epidemiologists

• Representing 43 health departments

• Wide range of expertise in syndromic surveillance

Trade-Offs• Timeliness

– Possible to collect and display daily, HD-specific ILI data (2-3 day lag for most HDs, including censoring for dates with incomplete reporting)

– Instability of daily data: most recent 2-3 day “trends” not consistently born out by subsequent observations

• Flexibility in ILI syndrome criteria– Allowed by using criteria “validated” by state/local

flu surveillance experience– Variability in amplitude of signal precluded

comparisons of H1N1 impact or summary estimate of H1N1 ED visits

Next Steps• Identification of EDs participating in Distribute and

ILINet to prevent duplication

• Assignment of ED surveillance POC at health departments and collaboration with influenza coordinators

• ILINet and Distribute comparison– CSTE recommended continuing to display Distribute data

separate from ILI-Net (aka, co-visualize)

• Increase coverage (ongoing)

• Address variability in ILI criteria (aka “Harmonize” ILI criteria)

Acknowledgements• ISDS Staff and Volunteers• Public Health Informatics Institute (PHII)• Project liaisons from NACCHO/CSTE/ASTHO• Support to ISDS

– Tufts Health Care Institute (THCI)– Markle Foundation

• CDC:– NCIRD, Influenza Division– OSELS & former NCPHI – H1N1 response team– OPHPR

For more information please contact Centers for Disease Control and Prevention1600 Clifton Road NE, Atlanta, GA 30333Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: cdcinfo@cdc.gov Web: www.atsdr.cdc.gov

Thank You!