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-
Noncommercial 3.0 Unported License (http://creativecommons.org/licenses/by-nc/3.0/), permitting all non-commercial use, distribution, 
and reproduction in any medium, provided the original work is properly cited.

ISDS 2014 Conference Abstracts

Monitoring Respiratory Syncytial Virus Regionally 
In Children Aged < 5 Years Old Using Emergency 
Department and Urgent Care Center Chief Complaint 
Data in Florida’s Syndromic Surveillance System, Week 
1, 2010 - Week 32, 2014
Heather Rubino*, David Atrubin and Janet J. Hamilton

Epidemiology, Florida Department of Health, Tallahassee, FL, USA

Objective
In Florida, pre-approval of prophylactic treatment by insurance 

companies is tied to seasonality. Previous analyses determined that 
Florida’s syndromic surveillance system (Electronic Surveillance 
System for the Early Notification of Community-based Epidemics 
[ESSENCE-FL]) was capable of monitoring Florida’s statewide RSV 
seasonality. This analysis aims to determine if ESSENCE-FL can 
also be used to describe RSV and RSV-associated hospitalizations in 
children < 5 years by region and season.

Introduction
National studies estimate that respiratory syncytial virus (RSV) is 

responsible for one in 38 emergency department (ED) visits for children 
< 5 years old. The Council for State and Territorial Epidemiologists 
position statement (13-ID-07): “RSV-Associated Pediatric Mortality” 
advocates for improved RSV surveillance including monitoring of 
RSV-associated pediatric mortality and hospitalizations. The goal of 
that data collection is to establish prevaccine baselines to evaluate 
vaccine effectiveness should one become available. As RSV is not 
reportable in Florida, RSV surveillance relies on a small subset of all 
Florida hospital laboratories to report data in aggregate and calculation 
of percent positive of all tests for RSV performed. These data assess 
virus activity, and do not allow for assessment of morbidity or age-
specific analysis. Moreover, this data is not complete or timely, most 
often becoming available a minimum of a week after the testing was 
conducted. Florida’s RSV surveillance efforts guide clinical decision 
making and insurance reimbursements. Florida’s RSV seasonality 
not only differs from the nation but there is strong variation among 
five distinct regions, as exemplified by southeast Florida where the 
RSV season is year round. In Florida, pre-approval of prophylactic 
treatment by insurance companies is tied to seasonality.

Methods
ESSENCE-FL was used to identify the number of visits to EDs and 

urgent care centers (UCCs) with RSV listed in the chief complaint 
or discharge diagnosis between Week 1, 2010 and Week 32, 2014. 
From a subset of the participating hospitals, ESSENCE-FL also 
provided information on admission status for children < 5 years old. 
Chief complaint data were available for all 213 facilities participating 
in ESSENCE-FL (180 EDs and 30 UCCs), admissions data were 
available for 171 participating facilities, and discharge diagnosis was 
available for some facilities. All of these data elements were sorted 
by RSV region.

Results
A total of 28,779 visits to EDs and UCCs were identified with a 

discharge diagnosis of RSV; children < 5 years old accounted for 
27,153 (94%) of all visits and children < 1 year old accounted for 
17,574 (61%) of all visits. Ten percent of ED and UCC visits of 

children < 5 years old with a discharge diagnosis of RSV resulted 
in hospital admission. Children < 1 year old accounted for 77% of 
those admissions. Trend analysis showed that chief complaint and 
discharge diagnosis data in children < 5 showed a high correlation 
with laboratory surveillance data from the state’s hospital-based RSV 
surveillance program. For each region, ESSENCE-FL data mirrored 
the existing knowledge about unique seasonality.

Conclusions
ED chief complaint and discharge diagnosis data accessed through 

a syndromic surveillance system can be used for effective, timely 
monitoring of RSV hospitalizations in children < 5 years old and may 
be a more efficient and complete means of monitoring seasonality 
of RSV activity by region and statewide compared to hospital-based 
laboratory data reporting. Additionally, this surveillance technique 
can efficiently monitor RSV activity as well as estimate hospital 
admissions due to RSV and may be a useful approach for other states 
with syndromic surveillance systems.

Keywords
Respiratory Syncytial Virus; syndromic; RSV; surveillance; 
seasonality

*Heather Rubino
E-mail: heather.rubino@flhealth.gov    

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 7(1):e50, 2015