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ISDS 2012 Conference Abstracts

Syndromic Surveillance at the New York State Veterinary
Diagnostic Laboratory
Kylius Wilkins*1, Bruce Akey2, 3, Belinda Thompson2, 3 and Daryl Nydam3

1Veterinary Services, USDA APHIS, Ames, IA, USA; 2NYSVDL, Ithaca, NY, USA; 3Cornell University, Ithaca, NY, USA

Objective
To assess the use and utility of a syndrome check list on the gen-

eral submission form of a high volume veterinary diagnostic labora-
tory, and compare to the results of a 2009 pilot study.

Introduction
The New York State Veterinary Diagnostic Laboratory (NYSVDL)

receives more than 100,000 diagnostic submissions a year that are
not currently used in any formal syndromic surveillance system. In
2009, a pilot study of syndrome classification schemes was under-
taken and in 2011 a new general submission form was adopted, which
includes a check list of syndromes, as part of the clinical history.

Monitoring submissions to a veterinary diagnostic laboratory for
increases in certain test requests is an established method of syn-
dromic surveillance (1, 2). The new general submission form allows
for clinician selected syndromes to be monitored in addition to test re-
quest.

Methods
We selected 420 “contract cases” from all submissions for bovines

since the implementation of the new form, May 2011, though Febru-
ary 2012. Submissions were reviewed for use of the new form, use of
the syndrome check list and tests requested. Test requests were as-
signed syndromes, if possible, to allow for comparison with the cli-
nician selected syndromes. 

The selection of cases was weighted towards the end of the period
as use of the new form increased with time and to a lesser extent to-
ward the beginning of the period in an attempt to find any early use
of the form. “Contract case” refers to New York State Department of
Agriculture and Markets subsidization of agricultural animal and herd
health testing done under specific guidelines. The benefit of “con-
tract cases” is the guidelines require a complete clinical history, which
should include selection of syndromes. Finally, selection was limited
bovine submissions as was done in the pilot study.

Results
16% (69/420) of submissions used the new form and of these 23

selected syndromes. As was seen in the pilot study the most com-
monly occurring syndrome in the clinical history was “Gastrointesti-
nal/Diarrhea” 56% (13/23). The next most common syndromes were
“Respiratory” (7/23), “Sudden Death” (6/23) and “Fever” (4/23).

Syndromes assigned based on test request followed a similar pat-
tern with “Gastrointestinal/Diarrhea” (166/254) and “Respiratory”
(52/254) best represented. An important difference was the syn-
dromes “Sudden Death” and “Fever”, which were never assigned to
a test request. These syndromes represent a new source of informa-
tion for surveillance. 

These results fit well with the pilot study which found the clinical
history was typically incomplete but contained additional informa-
tion for syndromic surveillance that was not available from monitor-
ing the test request alone and that monitoring syndromes or test
requests alone would provide incomplete information nearly a third
of the time.

Conclusions
We found monitoring syndromes, in addition to test requests, to

be useful and necessary for completeness. Monitoring clinical his-
tory provided additional information not available from test requests
alone. We recommend the syndromes “Sudden Death” and “Fever”
be monitored as these syndromes always provided additional infor-
mation not available in test requests. Other syndromes that provide
new information should be investigated across species and in vari-
ous clinical scenarios. Accumulating baseline data for all syndromes
is recommended to create more accurate models for syndromic sur-
veillance and improve data retrieval for retrospective studies. Despite
poor use of the new general submission form and the syndrome check
boxes, future compliance is likely to improve significantly with the
implementation of online submission and thanks to the continuous
training and consultation provided by the NYSVDL staff.

Keywords
Syndromic Surveillance; Veterinary Diagnostic Laboratory; Veteri-
nary Surveillance

Acknowledgments

We would like to thank Dr. Robert Gilmour and the Cornell University
Veterinary Investigator Program for supporting this research.

References

1. Shaffer, L., Funk, J., Rajala-Schultz, P., Wallstrom, G., Wittum, T.,
Wagner, M., Saville, W. (2007) Early Outbreak Detection Using an
Automated Data Feed of Test Orders from a Veterinary Diagnostic
Laboratory. In: D. Zeng et al. (Ed), BioSurveillance 2007, pp. 1–10

2. Glickman, L.T., Moore, G.E., Glickman, N.E., Caldanaro, R.J., Au-
coin, D., Lewis, H.B. (2006) Purdue University–Banfield National
Companion Animal Surveillance Program for Emerging and Zoonotic
Diseases Vector-Borne and Zoonotic Diseases. 6(1), 14-23.

3. Dorea, F.C., Sanchez, J., Crawford, W.R. (2011) Veterinary syndromic
surveillance: Current initiatives and potential for development. Pre-
ventive Veterinary Medicine 101, 1-17

*Kylius Wilkins
E-mail: kmw97@cornell.edu

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 5(1):e104, 2013