"The Network" Newsletter, Part 1: A Case for Distributed Flu Surveillance

A Case for Distributed Flu Surveillance: The International Society for Disease Surveillance (ISDS) Distributed Surveillance Taskforce for Real-time Influenza Burden Tracking and Evaluation (DiSTRIBuTE)

by Don Olson

This article is a part of a series that will be published in the Global Outreach newsletter, "The Network." A pdf version of "The Network" is coming soon!

The DiSTRIBuTE project was proof of concept effort initiated in October 2006 at the Annual ISDS Conference in Baltimore. It was developed as an approach to influenza morbidity surveillance based on existing state and local electronic syndromic surveillance capabilities and expertise. The projects design, implementation and evolution has involved ongoing collaboration with local, state and national health departments and a multidisciplinary team representing the ISDS membership. Supported by the Markle Foundation and the US Centers for Disease Control and Prevention (CDC), through a cooperative agreement with the National Association of County and City Health Officials (NACCHO), the ISDS DiSTRIBuTE Project has established a model for international distributed influenza surveillance by building on existing national, state and local programs.

The project enrolls volunteer health departments that conduct electronic syndrome-based surveillance from emergency department or outpatient settings. The participant agencies report electronically summarized daily counts of illness and total visits by broad age group (<2, 2-4, 5-17, 18-44, 45-64, 65+ yrs) and geographic area (as US 3-digit zip code, or larger region) to a secure internet site. Weekly aggregate ratios of febrile, respiratory and influenza-like syndromes, based on each region’s routine syndromic criteria for seasonal influenza, to total visits, are visualized as regional time-series and age-specific temporal epidemic response surface plots (see Figure).

Created with a distributed architecture, the DiSTRIBuTE project requires that all individual-level data remain local, and only broad aggregate counts by reported out. While many electronic syndromic surveillance efforts have focused on central collection in huge individual level databases, the DiSTRIBuTE project asks for data based on the question What summarized level of data are epidemiologically needed? And as the limitations of this model are reached, the project is investigating how standardization of syndromes, generalizability of the model, ad hoc investigation and system evaluation can be conducted through reverse queries, where the questions are asked of the participating sites, the data are reaggregated locally and the new summarized counts are shared.

The DiSTRIBuTE project’s approach is based on distributed data collection and analysis with central monitoring of summary information. For influenza-related morbidity, limiting the data request to the information that is truly the minimum required (summarized counts), the system has retained the ability to demonstrate robust monitoring, quickly and cost effectively. The very low risk of privacy breach has encouraged trust among data sources and has facilitated voluntary participation at both the national and international levels.

For more information, or if your city, county, state or national surveillance system is interested in joining the project, please contact Don Olson at distribute@syndromic.org




Figure: Draft visualizations by US jurisdiction, 2006-2009: fever, respiratory, influenza-like syndrome time-series as ratios, with national US CDC sentinel and viral influenza isolate data (top); and age-specific temporal epidemic response surface (TERS) plots (bottom).

Webinar: Technical Challenges from the Public Health Practice Community

The Public Health Practice and Research Committees of the International Society for Disease Surveillance invite you to attend a special two-hour webinar to learn of current challenges faced by public health practitioners. The webinar will be held on Thursday, May 28th, 2009 from 10:00 am to 12:00 pm EDT.

For more information, click on the flier posted below.

To register for the webinar, visit GoTo Meeting
Space is limited, so reserve your seat early!

March Research Committee Meeting

When: Thursday, March 26th, 10:00 am EDT.

Agenda:
1. Collaboration projects with the Public Health Practice Committee -- plans for a 2-hour May webinar. Review flier and Call for Abstracts.
2. Resources section at www.isds.wikispaces.org/resources, the forum, and other research sites; Stevan Reilly will give a tutorial on options for automatic notifications.

Discussion:
1. In preparation for the joint RC/PHPC webinar on May 28th, the Committee reviewed the publicity flier and the Call for Abstracts. The final edits for the Call for Abstracts were approved, and the letter will be sent out to the Public Health Practice Committee mailing list on Friday, March 27th. Any epidemiologists who are on the Research Committee were also invited to submit abstracts.

The publicity flier, developed for ISDS by Aptima, will go out on Monday, allowing some more time for any visual edits, if necessary. It is hoped that the publicity flier can be distributed to a wide cross-section of the research community at large. If you are interested in distributing the flier, please contact rviola@syndromic.org for an electronic copy.

2. Stevan Reilly explained how to sign up for Wikispaces updates using RSS. Wikispaces has two options for subscribing to RSS feeds: discussion updates and page changes. The notification of updates to a discussion thread is likely the most useful for ISDS members. Page and website edit notifications are more for the administrator.

Society members who don’t use RSS can also receive email updates with notifications of changes to the wiki. The email notifications are separate and distinct from RSS feeds, and are still very effective for those who don’t use an RSS reader.

The instructions for how to subscribe to the wiki RSS feed will be added to the wikispaces home page soon.


Next Meeting:
In lieu of the next bi-monthly Research Committee meeting, there will be a special 2-hour webinar presentation. For more information, click here.

March Literature Reviews Posted

Today the Literature Review subgroup of the Research Committee held its March Literature Review. The latest article summaries have been posted on the ISDS public wiki. Follow the link below to the "New Publications" page:

http://isds.wikispaces.com/NewPublications

The next Literature Review will be taking place on Thursday, April 23rd at 10:00 am EDT.

Call for Abstracts: Joint RC/PHPC Panel

On May 28th, 2009, the Research and Public Health Practice Committees will be co-hosting a webinar on the statistical and technological challenges faced by public health practitioners. At this time, the Committees are looking for informal abstract submissions to be presented. The following letter was sent out to members of the PHPC. If you are involved in routine health monitoring and would like to contribute, please see the contact information below.

-----------------------------------------------------------------

Dear ISDS Public Health Practice Committee Member,

I am writing to invite you to participate in two initiatives to improve the coordination between the research community and public health practice. The ISDS Research and Public Health Practice Committees are organizing two panels addressing the statistical and technological challenges faced by public health practitioners, and are now looking for abstract submissions. The first panel will be a two-hour webinar on May 28th, 2009 from 10:00 am to 12:00 pm EDT, and the second panel is a special session scheduled at the large American Public Health Association Conference in Philadelphia in November 2009.

The goal of the May webinar is to bring the current challenges faced by public health practitioners to the attention of the research community at large. Members of both Committees have expressed concern that much current research in disease surveillance has little application for public health practitioners. With an increasing emphasis on health information technology and exchange, public health practitioners need relevant, understandable analytic tools to manage information and make it useful. It is hoped that the invited panelists will be able to discuss concrete technical problems within the current (and future) constraints of practitioners.

If you are interested, please submit an informal abstract in the form of a problem description of up to one page. Your paragraphs should describe a practical problem potentially addressable with analytic tools. Write-ups will be considered for both the webinar and for APHA. No abstract format is required now, but those chosen for November may need formatting later. The collection of problem descriptions will be made available online, and some will be chosen for presentation. Submissions should follow these guidelines for maximum effectiveness:

a. Specific. Rather than “how do I combine different data sources”, more helpful would be: “I have ED visit data with data field information including … available on a daily basis, and nurse call data with information including … available on a weekly basis. How do I combine these sources of evidence for detection of excessive asthma exacerbations?” The more description of the application environment, the better for getting practical solutions.

b. The unavailability of data has kept many researchers away. If possible, state problems that can be approached without the need for data use agreements. If any authentic relevant data are available, say so in the description. Alternatively, a description of the data features might allow credible development and evaluation without real data.

c. Note any collaboration opportunities for new partnerships.

Write-ups should be submitted to rviola@syndromic.org no later than Friday, April 3rd.

Save the Date: 2009 ISDS Conference

Please save the date for the 2009 Annual ISDS Conference!

Where: Miami Beach Resort and Spa, Miami, FL
When: Pre-Conference Workshop -- Wednesday, December 2nd
Full Conference -- Thursday, December 3rd and Friday, December 4th

Stay tuned for more updates as the conference planning gets under way.

Questions? Email info@syndromic.org.

March Public Health Practice Committee Meeting

When: 23rd March, 2009; 12:00 pm EDT

Agenda items:
1. DiSTRIBuTE update from Don Olson
2. Ongoing discussion of joint RC/PHPC webinar
3. APHA panel planning

Discussion:
1. Don Olson gave a brief update on the DiSTRIBuTE project on today's call. On April 2nd and 3rd, ISDS and the Markle Foundation will be co-hosting a meeting for the DiSTRIBuTE working group in New York City. Current and prospective participants have been invited to come to New York City to discuss the latest details of the project.

2. Howard Burkom, Board Liaison to the Research Committee, led an ongoing discussion about the logistics of the joint Research/Public Health Practice Committee webinar to be held in May. The goal of the webinar is to bring the current challenges faced by public health practitioners to the attention of the research community at large. Members of both Committees have expressed concern that much current research in disease surveillance has little application for public health practitioners. With an increasing emphasis on health information technology and exchange, public health practitioners need relevant, understandable analytic tools to manage information and make it useful. It is hoped that the invited panelists (TBD) will be able to discuss concrete technical problems within the current (and future) constraints of practitioners. The 2 hour webinar is tentatively scheduled for late May, and the Committees hope to reach out to a wide range of professionals.

3. In addition to the May webinar, the Research and Public Health Practice Committees are also planning the details of a panel to be held at the November American Public Health Association conference in Philadelphia, where similar issues to those presented in May will be addressed. The Committees are looking to put together a panel of no more than 5 speakers to present on statistical and technological challenges in disease surveillance.

Next PHPC Meeting: Monday, April 27th at 12:00 pm EDT.

Welcome

Welcome to the new blog of the International Society for Disease Surveillance!

Check back here regularly and you should hope to find: news in disease surveillance, committee updates, news about ongoing projects, and more. This blog will serve as a liaison between other forms of ISDS communication and will keep you updated on happenings within the Society.

Have something to contribute or want to get involved? Please email info@syndromic.org for more information.