2014.ISDS.Abstracts.Final.pdf


ISDS Annual Conference Proceedings 2014. This is an Open Access article distributed under the terms of the Creative Commons Attribution-
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ISDS 2014 Conference Abstracts

Overcoming Operational Differences to Attain a National 
Picture for Novel Threats

Michael Coletta*, Achintya N. Dey, Matthew Miller, Peter Hicks and Umed Ajani

Centers for Disease Control and Prevention, Atlanta, GA, USA

Objective
Demonstrate that information from disparate syndromic 

surveillance (SyS) systems can be acquired and combined to 
contribute to national-level situational awareness of emergent threats.

Introduction
The May arrival of two cases of Middle East Respiratory Syndrome 

(MERS) in the US offered CDC’s BioSense SyS Program an 
opportunity to give CDC’s Emergency Operations Center (EOC) and 
state-and-local jurisdictions an enhanced national picture of MERS 
surveillance. BioSense jurisdictions can directly query raw data stored 
in what is known as “the locker.” However, CDC cannot access these 
data and critical functions, like creating ad-hoc syndrome definitions 
within the application are currently not possible. These were obstacles 
to providing the EOC with MERS information. BioSense staff 
developed a plan to 1) rapidly generate query definitions regardless 
of the locally preferred SyS tool and, 2) generate aggregate reports to 
support the national MERS response.

Methods
In consultation with state and local SyS epidemiologists, a 

common-use set of five MERS-specific query definitions were 
developed. The definitions focused on:

sensitivity,
specificity,
travel,
symptoms, and
ICD diagnosis codes.
Jurisdictions had various operating environments so all definitions 

were operationalized in SQL, R-Script, SAS, and ESSENCE query 
languages. The definitions and deployment guidance were provided 
to state and local jurisdictions. Also, a webinar was conducted to call 
for participation in MERS-like surveillance activities. CDC answered 
participants’ questions and setup weekly data reporting, which was 
collated into reports for the EOC.

Results
Call for Participation in MERS-like Surveillance Webinar: 192 

people attended, representing 60% of registrants. 35% of webinar 
participants completed an exit survey. 63% of exit survey respondents 
reported the activity directly applicable to their work. 78% felt they 
had a better awareness and understanding following the webinar. 
42% of exit survey participants reported an anticipated change in 
behavior, while 68% reported the webinar contained useable ideas 
and techniques.

Participation and Data Sharing Among CDC and Jurisdictions: 
Of the 11 jurisdictions providing data-sharing feedback, 64% were 
interested in sharing data and 9% were not.

In the end, 15 jurisdictions–6 large cities and 9 states–participated in 
MERS-like surveillance. They represented 822 facilities nationwide. 
Ten of 15 jurisdictions used a local SyS system to gather and report 
data. Surveillance activities began May 12 and continued through July 
31. Participating jurisdictions shared data only with CDC; they did
not share with each other.

Conclusions
Despite limitations and imperfections, surveillance reports of 

MERS-like visits enhanced the MERS national surveillance picture. 
CDC and partner jurisdictions quickly developed a novel, standardized 
set of definitions that were widely shared. Though limited by the use 
of differing systems, the community succeeded in providing CDC 
with MERS-like surveillance data. This national activity will inform 
future development of SyS applications.

Several operational limitations persisted and should be discussed 
among the community. The 15 participating jurisdictions covered a 
substantial population but did not approach full or uniform national 
coverage. Despite participants’ fairly quick response, activating the 
surveillance method was too slow for the MERS response. Thus, SyS 
data became ancillary to EOC operations. Participants never agreed 
how to share MERS-like surveillance data beyond CDC; no data were 
shared among jurisdictions. However, many stakeholders viewed this 
attempt to enhance the national MERS surveillance picture as a model 
to expand, and a success that may improve trust among jurisdictions 
giving hope for providing meaningful national SyS data in the future.

Keywords
Syndromic Surveillance; MERS; BioSense

Acknowledgments

CDC DHIS, CDC EOC, Participatory and Consultant State and Local 
Jurisdictions

*Michael Coletta

E-mail: mac0@cdc.gov    

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 7(1):e14, 2015