Fridays from the Archives: Ahmedabad Heat Action Plan

Friday, June 13, 2014: Ahmedabad Heat Action Plan

Last week, the ISDS Global Outreach Committee hosted a webinar on the Ahmedabad, India Heat Action Plan that was developed after a particularly deadly heat wave in the area in 2010. Dr. Dileep Mavalankar (Public Health Foundation of India) presented on the swift action he took following the 2010 heat wave.

The presentation focused first on the effects of the heat wave, including both the increased morbidity and mortality. Then, Dr. Mavalankar described how he developed the Heat Action plan for the area, how it was implemented, and what it contains. There are practical suggestions (i.e., wear light-colored clothing) and early warning systems (with color-coded alert levels). The plan has an important focus on building the capacity of emergency staff, such as ambulance staff and emergency room workers.

This webinar provides important information and suggestions for mitigating the effects of heat-related illness, which are especially valuable as we enter summer in the northern hemisphere. To learn more about this webinar or to review the recording please see the ISDS webinar archive.


This post is part of the series Fridays from the Archives. You can access all posts in the series here.

Written by Becky Zwickl, MPH, ISDS Public Health Analyst (bzwickl@syndromic.org). 

Fridays from the Archives: Viral Sovereignty

Friday, May 30, 2014: Viral Sovereignty

Since the beginning of May, two cases of MERS-CoV have been identified in the United States. In addition to prompting concerns related to the symptoms and case-fatality rate of MERS, the spread of disease also renews interest in a relatively new concept, viral sovereignty.

Viral sovereignty is defined as  "a sovereign state's ownership rights over pathogens found within their border." The term was first coined in 2007 when Indonesia failed to share samples of the H5N1 virus, claiming that they had viral sovereignty over the samples. Similarly, with MERS, there was a delay between when researchers identified the pathogen and when they notified authorities at the Ministry of Health (MOH). These circumstances raise a slew of issues for public health as researchers struggle between supporting intellectual property rights and the ensuring health of the public.

Last August Scott JN McNabb, PhD, MS and Affan Shaikh, MPH presented on the intersection between International Health Regulations (IHRs) and viral sovereignty in the webinar Global Public Health Surveillance, Governance, and Viral Sovereignty. With additional contributions from Qanta Ahmed, MD, Associate Professor of Medicine at SUNY Stony Brook, and Ziad Memish, MD, Deputy Minister of Public Health, Kingdom of Saudi Arabia, this presentation provides a dynamic combination of context, anecdotes, scientific knowledge, and in-person experience.

To learn more about this webinar or to review the recording please see the ISDS webinar archive.


This post is part of the series Fridays from the Archives. You can access all posts in the series here.

Written by Becky Zwickl, MPH, ISDS Public Health Analyst (bzwickl@syndromic.org). 

Fridays from the Archives: BioSense Series

Friday, May 16, 2014: BioSense Series

In the fall of 2013 ISDS and the BioSense Redesign team began collaborating on a BioSense 2.0 Webinar Series to provide current and potential BioSense users with a solid understanding of the platform's use.

Since October ISDS has co-hosted seven webinars covering a variety of platform and syndrome-specific topics. Whether you use BioSense as your sole syndromic surveillance system or are working to build a case to your state to sign the BioSense DUA, there are presentations that provide a cogent, clear argument for BioSense's efficacy. All the BioSense 2.0 Webinar Series webinars are available through this link.

Syndrome-specific topics

• Panel in Influenza-like Illness Surveillance - December 2013
• Using Surveillance to Prepare and Respond to Winter Weather: Extreme Cold, Ice, and Snow - February 2014
• Heat-related Illness Surveillance - April 2014

Beginning the process: onboarding and challenge grants

• Reports from the Field - October 2013
• The Kansas Experience, Health Information Exchanges, and Onboarding - March 2014

BioSense for Users

• Creating Syndrome Definitions Using RStudio - December 2013
• Features Update - January 2014

The final webinar in this series is scheduled for next Thursday, May 22, 2014, 3pm-4pm ET and will focus on data quality checks and assurance. If you're interested in attending you can learn more and register on the ISDS website.


This post is part of the series Fridays from the Archives. You can access all posts in the series here.

Written by Becky Zwickl, MPH, ISDS Public Health Analyst (bzwickl@syndromic.org). 

Fridays from the Archives: Bicycle-related Injury Surveillance

Thursday, March 20, 2014: Bicycle-related Injury Surveillance

Admittedly, it's not quite Friday yet, but it's never too early for Fridays from the Archives.

Today is the official start of spring. For some of you lucky folks that means flowers are blooming and it's warm enough for short sleeves. For those of us in New England, spring is more like the final gasp of winter. But we know that, soon enough, we will be able to shed our heavy coats and venture outdoors.

In Boston spring comes with an ever-growing flood of bicyclists. In just two years (between 2007 and 2009) there was a 122% increase in bicycle commuter ridership. As a result, beginning in 2007, Boston Public Health Commission (BPHC) started to quantify the bike injury burden and characterize bicycle-related injury (BRI) visits in Boston, based on emergency department (ED) visit data.

Marcus Rennick, MPH and Aileen Shen, MPH, described the process involved in developing and utilizing this novel BRI syndrome definition in an April 2012 ISDS webinar. A combination of chief complaints and ICD-9 CM codes were utilized to characterize ED visits as BRI. The BRI syndrome differs greatly from more commonly used syndromes (GI, ILI, etc.) and represents the malleability and flexibility of syndromic surveillance methodology in public health practice.

As a result of this project BPHC was able to identify both neighborhoods and age groups at greatest risk. This information is used to target bike lane development and educational activities, such as promoting helmet use when riding a bike.

For more information on Rapid Surveillance and Data Integration: A Syndromic Description of Bicycle-Related Injury in Boston please visit the ISDS website.



This post is part of the series Fridays from the Archives. You can access all posts in the series here.

Written by Becky Zwickl, MPH, ISDS Public Health Analyst (bzwickl@syndromic.org). 

Fridays from the Archives: Cancer Surveillance & 9/11

Friday, March 7, 2014: Cancer Surveillance & 9/11

Whenever there is a mass casualty event the full, long-term effects may not be clear for years. After the terrorist attacks in New York on September 11, 2001, the New York City Department of Health and Mental Hygiene (NYC DOHMH) quickly realized that there was a risk for excess cancer to anyone exposed to the area surrounding the World Trade Center. In September 2012 Jiehui Li, MBBS, MS, Steven D. Stellman, PhD, MPH, and James E. Cone, MD, MPH recapped NYC DOHMH's current state of post-exposure risk surveillance in the webinar, Association between WTC exposure and excess cancer risk.

Specifically focused on three types of cancer (prostate, thyroid, and multiple myeloma), this presentation provides background on the 3-wave survey methodology used to gather risk information. The type of exposure incurred on 9/11 is fairly well known and includes PAH, benzene, PCBs and asbestos. However, dosage information is unknown and latency periods for most cancers are long, complicating the conclusion of a link between exposure and subsequent cancer cases.

The webinar focuses mainly on methodology, results, strengths, and limitations. Key to the success of this project, though, is the fact that NYC DOHMH began surveillance within a year of the causal event.  This type of forward thinking allowed a comprehensive approach to monitoring the health of people exposed to 9/11 contagions.

For more information, and to view the full set of slides and webinar recording, please visit the webinar page on the ISDS website.

This post is part of the series Fridays from the Archives. You can access all posts in the series here.

Written by Becky Zwickl, MPH, ISDS Public Health Analyst (bzwickl@syndromic.org).

Fridays from the Archives: Surveillance & Integration

Friday, February 21, 2014: Surveillance & Integration

Public health practitioners are increasingly focused on understanding cross-border syndromic surveillance data. Here in the US, ISDS encourages inter-state data understanding and sharing through regional workshops. In Europe, practitioners have been working since 2010 on gathering data and creating a framework for integrating syndromic surveillance. This has occurred under the scope of work of the Triple-S project. 

In 2012 Duncan Cooper, a Registrar in Public Health under the UK's National Health Service,  spoke about gathering data from European countries on their syndromic surveillance systems. In Towards Integrated Syndromic Surveillance in Europe?, Dr. Cooper describes Triple-S's work to meet the objective of "increasing the European capacity for real-time or near-real time surveillance and monitoring the health burden of expected and unexpected health related events". 

First, the presentation addresses practical concerns. Prior to integrating syndromic surveillance systems, the project needs data. Not syndromic surveillance data, per se, but metadata on the systems themselves. For instance, who are the key stakeholders? What are individual syndromic surveillance systems used for? Is there even a syndromic surveillance system in all target countries?

To answer these questions the Triple-S project team identified key stakeholders and lined up site visits throughout Europe. They also sent questionnaires to 28 European Union countries, including subsequent in-depth follow up questionnaires. With this data, the project progressed to identifying next steps, including developing a minimum dataset, communication materials, common evaluation criteria, and checklists. 

Perhaps most importantly, this project established trust and communication between a variety of public health jurisdictions. Going forward, the EU can integrate reporting on syndromic surveillance functions such as outbreak detection and general public-health surveillance, a vital function in a very inter-connected world.

This post is part of the series Fridays from the Archives. You can access all posts in the series here.

Written by Becky Zwickl, MPH, ISDS Public Health Analyst (bzwickl@syndromic.org).

Fridays from the Archives: Meaningful Use & Ambulatory Data

Friday, February 7, 2014: Meaningful Use & Ambulatory Data

It's the first Friday of the month, which means the Meaningful Use Community Call is this afternoon (more info here). These calls act as a platform for public health practitioners to discuss their status with implementing the syndromic surveillance objective of Meaningful Use, often looking towards future Meaningful Use stages. We've had many discussions surrounding what to do with Eligible Professionals, or EPs, who are interested in submitting data. Currently, many jurisdictions are putting these EPs in queues until they have the capacity to process their data. 

But why is receiving ambulatory data an issue at all? What makes ambulatory data unique from existing Emergency Department (ED) data?

One of the largest challenges in incorporating ambulatory data is sheer volume. Corey Spears and Michelle Siefert plainly lay out this dilemma in Discovering the New Frontier of Syndromic Surveillance: A Meaningful Use Dialogue on Inpatient and Ambulatory EHR Technology. At an ED visit the patient, at least ostensibly, is encountering some type of emergency to prompt the visit. In ambulatory settings, routine visits are common. Additionally, there are a wide variety of ambulatory care providers. Do public health departments want data from internists? Almost certainly. But do they also want data from dermatologists? That's a bit less certain.

This webinar is particularly interesting because it presents the information from the perspective of EHR vendors, an important stakeholder group that has substantial investment in Meaningful Use processes.

Interested in learning more? Join our Meaningful Use Community calls and view the webinar recording on the ISDS website.

This post is part of the series Fridays from the Archives. You can access all posts in the series here.

Written by Becky Zwickl, MPH, ISDS Public Health Analyst (bzwickl@syndromic.org). 

Fridays from the Archives: Schools & Flu

Friday, January 24, 2014: Schools & Flu

Schools are often, for lack of a better descriptor, prime places for infectious disease transmission. But how do common infectious diseases, like seasonal influenza, move through a school? Are there specific patterns that could be accounted for to mitigate transmission?

It turns out that certain factors, such as social networks, may affect not only epidemic impact but also intervention effectiveness.  Through extensive modeling Gail Potter, PhD explores these social contact factors in School Disease Transmission: Has the time come for coordination between monitors and modelers? 

Of course, the other half of the title indicates needed coordination between modelers like Gail and monitors like Guoyan Zhang, MD, MPH and Anthony Llau, MPH, PhDc  who monitored ILI for Miami-Dade County in Florida. Daily school absenteeism surveillance used in coordination with evolving models of transmission could improve analysis of the absenteeism data. This is especially important since, as the presenters mention, absenteeism may not always equal true illness (or illness at all).

To learn more about flu and school absenteeism surveillance, and the modeling that can aid in analysis and intervention decisions, be sure to watch the full webinar from October 18, 2011 on our website.


This post is part of the series Fridays from the Archives. You can access all posts in the series here.


Written by Becky Zwickl, MPH, ISDS Public Health Analyst (bzwickl@syndromic.org)

Fridays from the Archives: Smart Phones

Friday, January 10, 2014: Smart Phones

At the 2013 ISDS Conference in New Orleans in December we learned about innovative surveillance methods used across the globe. As technology evolves, so too does the ability to improve surveillance strategy and technique.

The Boston University School of Public Health Electronic Data Capture Team worked on integrating existing technologies in new ways, mainly focusing internationally. In 2011 three members of the team, Marion McNabb, MPH, Laura Khurana (then MPH candidate) and Chris Gill, MD, MS presented on their work in Data Collection, Management, and Surveillance: Using Smart Phones in Smart Ways.

Data from smart phones have a number of advantages including accessibility and ease of transmission and receipt. Though some technologies see sudden surges with equally sudden declines in use, cellphone use in general is still rapidly increasing worldwide. As of 2011, phones had been successfully used in surveillance for a number of uses including: Dengue Fever monitoring in Mexico; Real-time outbreak monitoring in mass gatherings, such as the 2009 Hajj; and infectious disease reporting after an earthquake in China (additional details on slide #36 of presentation).

With a number of disparate uses, smart phone surveillance can work with traditional surveillance methods, as well as in place of them. In low resource settings this combination is particularly useful.

This post is part of the series Fridays from the Archives. You can access all posts in the series here.


Written by Becky Zwickl, MPH, ISDS Public Health Analyst (bzwickl@syndromic.org)

Fridays from the Archives: Games Galore

Friday, November 29, 2013: Games Galore

In honor of US Thanksgiving, today's Fridays from the Archives post focuses on a topic many of us encounter before or after turkey consumption: games.

Though your Thanksgiving day gaming interests may be more in the realm of American football, Timothy Dasey's 2011 presentation on EpiDIG shows how virtual games can provide an effective mental workout to supplement the physical. In Using Gaming Tools to Train Disease Surveillance Professionals and Investigate Next-Generation Capabilities, we learn the rationale behind gaming as a surveillance tool. Gaming not only allows people to hone their decision making abilities but it can also be instrumental in developing reaction strategies for events that are rarely seen and therefore difficult to prepare for.

Gaming is not sufficient for ensuring preparedness, but it has substantial potential as another tool in the arsenal of readiness. EpiDIG games are developed to supplement possible weaknesses of traditional emergency preparedness exercises, including a lack of feedback. The ability to simulate, for instance, a food borne disease outbreak, and receive direct feedback to the response and decision-making is extremely valuable to surveillance professionals. Since Dasey's presentation in 2011 MIT Lincoln Labs has continued to develop serious gaming systems and utilize them with public health practitioners (read more).

The full set of slides and recording from Timothy Dasey, PhD (October 27, 2011) can be found in the ISDS Webinar Archive.

This post is part of the series Fridays from the Archives. You can access all posts in the series here.


Written by Becky Zwickl, MPH, ISDS Public Health Analyst (bzwickl@syndromic.org)

Fridays from the Archives: Weather and Surveillance

Friday, November 15, 2013: Weather and Surveillance

Extreme weather events and infectious disease outbreaks have always struck me as being similar; both are highly unpredictable events and outcomes depend on a variety of biological and environmental factors. So, I was excited to see that there may be an interaction between the two when I found Absolute Humidity and Influenza Transmission Dynamics in the ISDS webinar archives.

In this 2010 webinar Dr. Jeffrey Shaman presents his thoughts on how a confluence of meteorological factors can affect the rates of influenza transmission. To set the stage, Dr. Shaman describes an experiment he found through a colleague; results showed that colder temperatures and lower relative humidity favor influenza transmission. He then describes his work in expanding the initial experiment to further explore humidity and temperature effects on influenza.

The meat of the presentation explores two hypotheses. First, that virus-laden aerosols are produced more efficiently at lower absolute (or specific) humidity. The second hypothesis posits that influenza virus survival increases as humidity decreases, which means that that airborne virus is viable longer at a lower humidity.

Perhaps my favorite part of this webinar occurs when Dr. Shaman explores whether or not epidemic influenza onset is associated with changes in humidity in the US. This specific case study of sorts provides real, concrete examples of how weather data may be applicable to public health.

If you are interested in the intersection of meteorology and epidemiology I recommend you set aside 60 minutes to listen to this webinar. A full recording is available here.

This blog post is the third installment of Fridays from the Archives. You can access all posts in the series here.


Written by Becky Zwickl, MPH, ISDS Public Health Analyst (bzwickl@syndromic.org)

Fridays from the Archives: Understanding EMS Data Sources

Friday, November 1, 2013: Understanding EMS Data Sources

With Meaningful Use an increasingly important focus of state- and local- public health agencies, the usual suspects of data sources (i.e., hospital-based) seem to be central to most surveillance conversations. However, other data sources, such as those from EMS (Emergency Medical Services) not only offer unique insight, but may also complement streams of emergency department and hospital inpatient data.

In May of 2010 ISDS hosted a presentation, Understanding the Spectrum of Emergency Medical Services (EMS) Data Sources and their Variation by Community, that delves in deep to the specifics of EMS data flow, structure, and use.

For instance, did you know that the approaches to recording EMS calls differs widely? Some dispatch centers use an unstructured process, others use a locally developed structured process, while still others use an international standard for structured data. 

Once the information is in the system, the presenters describe a number of unique ways in which EMS data can help address the growing problem of ambulance diversions in the United States. In particular, they describe the development of a model that can aid EMS and hospitals in better managing the health of the community by predicting diversions and potentially avoiding them altogether. Additionally, presenters describe some drawbacks of EMS data, such as the obstacles in obtaining subsequent hospital outcome data and the limitations of use when the data is aggregated.

Thank you to Todd Stout, Abey Kuruvilla and Christopher Olola for an interesting and informative presentation. A video recording of the full presentation and copies of the slides are available in the ISDS Webinar Archive at: http://www.syndromic.org/component/content/article/31/250

This blog post is the second installment of the series, "Fridays from the Archives". The first post can be accessed here.

Written by Becky Zwickl, MPH, ISDS Public Health Analyst (bzwickl@syndromic.org)

Fridays from the Archives: Twitter Data

Did you know that there's a whole archive of past ISDS webinars, easily accessible and searchable by key terms? My new bi-weekly series, Fridays from the Archives, will select one webinar from the ISDS vault and summarize its content.

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Friday, October 18, 2013: Twitter Data

This morning on the bus I found myself mindlessly scrolling through my twitter feed, inspiring my first Fridays from the Archives keyword search of "twitter data". That brought me to the June 28, 2012 webinar, "Application and Visualization of Twitter Data for Disease Surveillance". Presented by Courtney Corley (US), Marcel Salathe (US), and Mark Cameron (Australia), this webinar looked at a variety of details that are integral to effective surveillance using twitter.

In particular, the presentations focused on:

• Filtering and processing;
• Analysis; and
• Presentation of findings.

For me, the highlight of this webinar was seeing the myriad and differing ways in which twitter data was utilized by the three presenters. For instance, Mark Cameron's presentation notes twitter's use in surveillance of the February 2009 Victorian bushfires, whereas Courtney Corley summarized the importance of understanding twitter's unique terminology and presenting data visualizations. Finally, Marcel Salathe described how you can use twitter data as part of a health behavior assessment.

If you're interested in twitter, crowd sourcing, or social media in general, this webinar will provide you with ideas for effectively using new data sources without ignoring potential drawbacks of social media data.

A video recording of the full presentation and copies of the slides are available in the ISDS Webinar Archive (http://www.syndromic.org/component/content/article/29/218).

I hope you've enjoyed this first installment of Fridays from the Archives. Please let me know if you have any suggestions for improving this series!

Written by Becky Zwickl, MPH, ISDS Public Health Analyst (bzwickl@syndromic.org)