Harold H. CollinsInformation Technology Specialist

Epi Info™ Health Surveillance Use Korean Public Health Surveillance Conference

31 March 2011

Epi Info™ Health Surveillance Use

Public Health Software for Microsoft

Windows 98, 2000, XP, Vista, and Windows 7

Office of Surveillance, Epidemiology, and Laboratory Services

Epidemiology and Analysis Program Office

Epi Info™ Health Surveillance Use Cases

Epi Info™ Viral Hepatitis Surveillance System? Background of Use Cases Objectives of the surveillance system Surveillance system design using Epi Info™ Outcome of system deployment

Community Assessment for Public Health Response (CASPER) Background of Use Cases Objectives of the assessment system Assessment system design using Epi Info™ Outcome of system deployment

Other Use Cases

Questions

Jaundice Surveillance Background

One of the largest HEV epidemics in Africa was identified in 2008. This outbreak resulted in more than 10,000 cases and 160 deaths recorded by December 2008.

A ministry of health requested the Division of Viral Hepatitis (DVH) at the U.S. Centers for Disease Control and Prevention (CDC) to assist with investigation of this HEV epidemic.

After the initial investigation and report, the ministry of health, cognizant of the prevailing situation and interested in other lingering questions, invited DVH to monitor the current status of HEV infection by establishing a jaundice surveillance system.

Objectives of the Surveillance System

Three primary objectives of the surveillance system

Enumerate acute jaundice cases • Determine age and geographic distribution• How widespread is the infection in the survey region

Determine what proportion of acute jaundice cases is attributable to HEV• Collect laboratory data for each case

o Anti-HEV IgMo Anti-HAV IgMo Anti-HCV

Assess the current magnitude of HEV as a public health problem• Anti-HEV IgM and Anti-HEV IgG immunoglobulin levels• Report of total cases by Epi week

Surveillance System Design

The two teams worked together to refine the requirements Two Epidemiologist Two Information Technology Specialist

Information Technology Team Developed the forms, menus, analysis, and system reports Tested menus and system function Created a detailed 16-page instruction manual

Epidemiology Team Tested the surveillance system Deployed system to the region and provided user training Collected and analyzed resulting data

Outcome of System Deployment

The Jaundice Surveillance is in use today

Data is regularly sent to the epidemiologist

Data is being analyzed to monitor the magnitude of HEV as a public health problem

The ministry of health is kept cognizant of the prevailing situation

CASPER Background

The Community Assessment for Public Health Response (CASPER) model is used to assist local and regional health departments in responding to natural disasters in their communities.

The objective of a community assessment is to document population-based needs following a natural disaster or manmade disaster. This method has been successfully used in responding to hurricanes, floods, and ice storms.

After the initial questionnaire development the Epi Info Team was asked to use the existing questionnaire to develop an electronic Epi Info data input form.

Objectives of the Assessment System

The primary objectives of the Assessment system

Identify health and service needs and hazards that might not be immediately obvious

o Safe food and water supplieso Sources of power (e.g., gas, electricity)o Communication services (e.g., telephone, radio)o Medical and public health care for both acute and

chronic conditions

Target relief efforts at the people who need them most

Identify which needs have been successfully met

Mortality surveillance and reporting

Assessment System Design

Initial assessment form designed by state health department

Epi Info™ Team asked to create Epi Info electronic data entry forms

Form designed by the Epi Info™ Team

State health department users tested the forms

Assessment system used to collect data and perform Ad hoc reports

Development of menus and standard report are a possible addition to the system

Assessment System Use

The system is used by the state health department

System runs on any windows personal computer

It is ready for deployment any time a natural or manmade disaster strikes

Floods Earth quakes Hurricanes Wild fires Ice storms

Other Use Cases

CDC Influenza Sentinel Surveillance System Early detection of Influenza outbreak Identify Influenza strains

Routine Immunization and Data Management Collect and feed-forward immunization data Monitor quality of data through routine reports

Surveillance System for Polio eradication Collect immunization data Identify wild Polio cases

Social Violence Survey System Detect and document rates of social violence Develop better understanding for improved intervention

programs

More Use Cases

Assessment of Mercury (Hg) Exposure in a Puerto Rican High School, January 2011 How many were exposed to the Hg If they had any signs or symptoms related to Hg toxicity

and how long have they had the symptoms Epi Info analysis demonstrated no correlation of

symptoms and Hg levels This spill did not cause harmful health effects on the

exposed population

Johns Hopkins Bloomberg School of Public Health 2010, Johnson & Johnson Community Health Care Program Implementing programs using Epi Info to prevent

obesity and prevent or manage related chronic diseases such as diabetes

CDC Epi Info™ Team

José Aponte Training Coordinator David Brown Epi Info™ 7 Developer Harold Collins Community Liaison James Haines Epi Info™ 7 Developer Asad Islam Epi Info™ Team Lead Erik Knudsen Epi Info™ Help Desk Roger Mir Custom Applications David Nitschke Epi Info™ Technical Lead

Epi Info™ Help Desk (epiinfo@cdc.gov)

Resources and Technical Support

Download and install the latest Epi Info™ program from the website at http://www.cdc.gov/epiinfo

Helpline epiinfo@cdc.gov or call 404.498.6190

Additional training resources are available online at: http://wwwn.cdc.gov/epiInfo/html/tutorials.htm

Epi Info™ Community of Users in phConnects http://www.phconnect.org/group/epiinfo

Send your comments and suggestions to hcollins@cdc.gov or epiinfo@cdc.gov

For more information please contact Centers for Disease Control and Prevention

1600 Clifton Road NE, Atlanta, GA 30333Telephone, 1-800-CDC-Info™ (232-4636)/TTY: 1-888-232-6348E-mail: cdcinfo@cdc.gov Web: www.cdc.gov

Questions?

Office of Surveillance, Epidemiology, and Laboratory Services

Epidemiology and Analysis Program Office

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