Lauren Lewis, MD, MPH

Health Studies BranchEnvironmental Hazards and Health EffectsNational Center for Environmental Health

Centers for Disease Control and Prevention

Improving Disaster Surveillance: An Environmental Epidemiology Perspective

Health Studies Branch(HSB)Disaster Epidemiology and Response

Types of disasters Natural (extreme weather events) Technological (chemical and radiologic events) Complex emergencies

Focus: epidemiologic support to state and local public health Accurate data for public health decision-making

Hurricane Sandy 2012American Samoa Tsunami

Deepwater Horizon Oil Spill

National Heat Wave 2012

Types of Epidemiologic Activities

Public health surveillance Track illness, injury and death Identify outbreaks Syndromic, laboratory, morbidity, mortality

Rapid needs assessments Identify shelter, community and health care needs to

allocate resources CASPER

Program evaluations Assess success and identify barriers to improve

response efforts Epidemiologic research

Identify risk/protective factors for injury , illness and death• Case-control, cohort, outbreak investigations, case series

Utility of Epidemiologic Data

• Justify and target resources

• Improve mitigation strategies to prevent future illness and death

• Provide situational awareness

• Guide individual, community and PH preparedness

Prepared-ness

Response

Recovery

Mitigation

# deaths and illnesses, identify vulnerable pop or acute threats

Estimate unmet infrastructure and health care needs

Identify risk and protective factors

Evaluate interventions

Surveillance

Rapid needs

assessments

Program evaluations

Epidemiologic research

Why Conduct Disaster Surveillance?

Provide situational awareness Track morbidity and mortality Detect disease outbreaks

Determine action items such as resource allocation

Target interventions

Facilitate future disaster planning

Data Flow Mortality•ME/coroners• Hospitals• Nursing home• Funeral home• DMORT office•ARC

Public Health• County• Region• State

Emergency Operations/

IMS

Morbidity• Hospitals•Clinics•Shelters• Service delivery sites

CDCOther States

Report

Data Data

Current HSB Disaster Surveillance Activities

Build capacity Provide surveillance tools and training

Provide technical assistance during disasters

Conduct surveillance Partner with American Red Cross (ARC) and poison centers Utilize National Poison Data System (NPDS)

Analyze data and disseminate findings

Evaluate surveillance efforts

Provide Surveillance Tools and Training

Provide standardized disaster surveillance forms Includes morbidity and mortality Modifiable for any type of disaster Available at http://www.bt.cdc.gov/disasters/surveillance

Conduct disaster epidemiology training Includes surveillance and CASPER

Conduct Surveillance with American Red Cross

Monitor and analyze ARC mortality reports

Facilitate morbidity surveillance in ARC shelters

Conduct Poison Center Surveillance

National Poison Data System (NPDS) Monitors calls to poison centers from clinicians and the

public Provides national, near real-time surveillance data

Poison center utility during disasters Track CO poisonings Monitor public concern Provide hotline support

Radiologic Disaster Surveillance

Enhanced NPDS to detect and monitor radiologic events

Developed a standardized data collection tool Collect data at community reception centers Multipurpose: surveillance, acute triage, and long-term

follow-up Available at

www.emergency.cdc.gov/radiation/crc/vcrc.asp

Exploring strategies to improve screening capacity

Disaster Surveillance Challenges

Absent baseline information

Denominator data difficult to obtain

Damaged healthcare infrastructure

Need for rapid information

Disaster Surveillance Challenges

Competing priorities

Data collection varies between states and events

No incentive to share data with CDC

No electronic mechanism for data sharing

Potential Strategies to Improve Disaster Surveillance

Develop surveillance guidance

Increase utilization of existing surveillance during disasters Biosense, National Poison Data System (NPDS), American

Red Cross data, Environmental Public Health Tracking (EPHT), State-based syndromic surveillance, NCHS mortality data

Explore the utility of nontraditional sources Track internet and social media reports

Active mortality surveillance