2014.ISDS.Abstracts.Final.pdf


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ISDS 2014 Conference Abstracts

Use of Syndromic Data for Enhanced Surveillance: 
MERS Like-Syndrome
Achintya N. Dey*1, Matthew Miller2, Michael Coletta1 and Umed Ajani1

1DHIS, CDC, Atlanta, GA, USA; 2McKing Consulting, Atlanta, GA, USA

Objective
To identify and monitor Middle East Respiratory Syndrome 

(MERS) like syndromes cases in the syndromic surveillance system.

Introduction
Centers for Disease Control and Prevention’s (CDC) BioSense 

system receives near real-time health care utilization data from 
number of sources, including DoD and VA outpatient facilities, and 
nonfederal hospital EDs in the US to support all-hazards surveillance 
and situational awareness. However, the BioSense system lacks some 
critical functions such as creating ad hoc definition of syndrome 
or ad hoc query tool development. This limits CDC Emergency 
Operations Center’s (EOC) ability to monitor new health events such 
as MERS - a viral respiratory illness first reported in Saudi Arabia in 
2012. In May 2014, CDC confirmed two unlinked imported cases of 
MERS in the US - one in Indiana, the other in Florida. Upon report 
of a MERS case in Indiana, staff initiated joint efforts with EOC and 
several affected jurisdictions to enhance the surveillance of MERS 
irrespective of jurisdictions’ preferred surveillance system.

Methods
In consultation with the state and local jurisdictions, five case 

definitions were developed to monitor MERS like syndromes: (1) 
was designed to search chief complaint: any mention of MERS or 
any mention of CoV or any mention of Oman or any mention of 
Camel or MiddleEast or Arabian or AbuDhabi or Egypt or Jordan or 
Kuwait or Qatar or UAE or United Arab Emirates or Bahrain or Iraq 
or Iran or Israel or Lebanon or Palestin or Saudi or Syria or Yemen; 
(2) was designed to focus solely on the travel terms: any mention 
of Oman or any mention of MiddleEast or Arabian or AbuDhabi or 
Egypt or Jordan or Kuwait or Qatar or UAE or United Arab Emirates 
or Bahrain or Iraq or Iran or Israel or Lebanon or Palestin or Saudi 
or Syria or Yemen; (3) was meant to be more specific, requiring the 
mention of both MERS and Travel: Part A search term included 
(MERS and Travel): any mention of MERS and any mention of Oman 
or any mention of Camel or MiddleEast or Arabian or AbuDhabi or 
Egypt or Jordan or Kuwait or Qatar or UAE or United Arab Emirates 
or Bahrain or Iraq or Iran or Israel or Lebanon or Palestin or Saudi or 
Syria or Yemen) or Part B search term included (CoV AND Travel): 
any mention of CoV and any mention of Oman or any mention of 
Camel or MiddleEast or Arabian or AbuDhabi or Egypt or Jordan or 
Kuwait or Qatar or UAE or United Arab Emirates or Bahrain or Iraq 
or Iran or Israel or Lebanon or Palestin or Saudi or Syria or Yemen; 
(4) was focused on secondary spread: any mention of Fever and 
Pneumonia or any mention of Fever and Acute Respiratory Distress; 
(5) used ICD-9-CM, and ICD-10-CM: 079.82, 480.3, V01.82, B34.2, 
B97.21, J12.81, U00-U49, U04.9.

These five case definitions were then operationalized in SQL, 
R-Script, SAS, and ESSENCE languages and sent out to each 
participating state and local jurisdictions to run the weekly query 
on their syndromic surveillance systems for sharing the results with 
the CDC. BioSense staff compiled the results and set up a weekly 
reporting system on MERS like syndrome cases to EOC.

Results
From May through July, 2014, fifteen reporting jurisdictions 

participated in MERS enhanced surveillance. These 15 reporting 
jurisdictions reported from 822 civilian hospitals ED facilities. 
BioSense staff created weekly reports for the CDC’s EOC. Reports 
included five case definitions and a table reporting jurisdiction name, 
date, number of MERS case investigated and number of MERS cases 
ruled out. During this enhanced surveillance time period 171 probable 
MERS cases were identified and all of them were ruled out.

Conclusions
In spite of limitations such as low participation and lack of 

agreement among the jurisdictions in sharing data, CDC BioSense 
staff was able to provide meaning full data to EOC for enhanced 
surveillance on MERS like syndrome. Similar collaborative efforts 
between BioSense programs, CDC subject matter experts and 
jurisdictions will help develop more comprehensive definitions to 
conduct enhanced surveillance at the national level using multiple 
syndromic surveillance systems.

Keywords
MERS; syndromic surveillance; ED facilities

Acknowledgments

Participating State and Jurisdictions

*Achintya N. Dey
E-mail: aad2@cdc.gov    

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 7(1):e69, 2015