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

Game Plan: Communicable Disease Surveillance for 
Super Bowl XLVIII – New Jersey, 2014

Teresa Hamby*1, Andrew Walsh2, Lisa McHugh1, Stella Tsai1 and Edward Lifshitz1

1New Jersey Department of Health, Trenton, NJ, USA; 2Health Monitoring Systems, Inc, Pittsburgh, PA, USA

Objective
To describe the surveillance planning and activities for a large-

scale event (Super Bowl XLVIII) using New Jersey’s syndromic 
surveillance system (EpiCenter)

Introduction
In the summer of 2013, the New Jersey Department of Health 

(NJDOH) began planning for Super Bowl XLVIII to be held on 
February 2, 2014, in Met Life Stadium, located in the Meadowlands 
of Bergen County. Surveillance and epidemiology staff in the 
Communicable Disease Service (CDS) provided expertise in planning 
for disease surveillance activities leading up to, during, and after the 
game. A principal component of NJDOH’s Super Bowl surveillance 
activities included the utilization of an existing online syndromic 
surveillance system, EpiCenter. EpiCenter is a system developed by 
Health Monitoring Systems, Inc. (HMS) that incorporates statistical 
management and analytical techniques to process health-related data 
in real time. As of February, 2014, 75 of New Jersey’s 81 acute care 
and satellite emergency departments (EDs) were connected to this 
system. CDS staff primarily used EpiCenter to monitor ED visits for 
unusual activity and disease outbreaks during this event. In addition, 
NJDOH and HMS implemented enhanced reports and expanded 
monitoring of visit complaints.

Methods
HMS and CDS staff collaboratively established enhanced 

algorithms to improve statewide ED data monitoring around the 
game-related activities in addition to the ongoing analyses already 
included in EpiCenter. New Jersey EDs were requested, via a HAN 
message, to use “Super Bowl” in their chief complaint fields to flag 
visits from patients who were involved in game-related activities, and 
these visits were detected automatically. As well, the implemented 
enhancements monitored out-of-town registrations, registrations 
from participating metropolitan areas (Seattle & Denver), novel 
word complaints and unlikely complaints. HMS developed a report 
summarizing these enhanced data points for facilities in proximity 
to the stadium. These reports were sent to CDS surveillance staff at 
6-hour intervals beginning on January 27, 2014, one week prior to the 
game, and continued until one week after the game (February 10th).

Results
Expected increases in visits to facilities due to the influx of visitors 

related to the Super Bowl occurred with no anomalies of concern 
noted. Staff maintained an ongoing comparison of ED visits in 2013 
and 2014 to quickly note any dramatic differences (See Figure 1). 
No differences of concern were noted when accounting for day of 
week changes from year to year. Twenty ED visits using the key word 
“Super Bowl” were reported in facilities around the stadium with 17 
records coming from one location. In this case, 16 records reflected 
a misuse of the key word for vomiting cases. The 17th record was a 
vomiting case related to a Super Bowl event. Continued monitoring 
showed nothing widespread or sustained in connection to the case. 
Otherwise, use of the key word was associated with one assault 
and 2 injuries. The six-hour interval reports provided an important 

overview to CDS surveillance staff that was summarized in updates 
to NJDOH’s Emergency Command Center. No differences of concern 
were noted when accounting for day of week changes from year to 
year.

Conclusions
Large-scale events pose a challenge to existing surveillance 

systems where it is expected that additional populations potentially 
will impact the volume of alerts generated. Implementing enhanced 
algorithms in an existing system allows better determination between 
expected anomalies and those that might be of greater concern. The 
collaboration between NJDOH and HMS, as well as system flexibility 
within EpiCenter, helps minimize unnecessary response efforts by 
public health and emergency preparedness personnel during a large-
scale event such as Super Bowl XLVIII.

Keywords
Syndromic Surveillance; New Jersey; EpiCenter; Large Scale Event

*Teresa Hamby

E-mail: Teresa.Hamby@doh.state.nj.us    

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 7(1):e2, 2015