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BACKGROUND: Throughout the history of syndromic surveillance, the early detection of large outbreaks using these systems has proved to be challenging. Syndromic surveillance systems, however, have been proven to be valuable for trend analysis, situational awareness, and producing periodic surveillance reports. Finding unreported individual cases or small clusters of illness/disease of public health importance has proven to be one of syndromic surveillance’s successes. The Florida Department of Health (FDOH) utilizes the Electronic Surveillance System for the Early Notification of Community-based Epidemics - Florida (ESSENCE-FL) as its syndromic surveillance system. Four data sources contribute to ESSENCE-FL: 1 ) emergency department/urgent care center (ED\UCC) data, 2) poison control data, 3) death record data, and 4) reportable disease data.
METHODS: A concatenated field in ESSENCE-FL was created which allowed for efficient free text queries of the ED\UCC data source. This single field displays the chief complaint and the discharge diagnosis in a single field labeled the CCDD (Chief Complaint Discharge Diagnosis). A Visits of Interest query was programmed into ESSENCE-FL with the intent of facilitating the identification of these events of public health importance. Additionally, Florida’s electronic reportable disease reporting system (Merlin) was modified to allow disease investigators to note when a case was identified from the ESSENCE-FL data. Likewise, public health epidemiologists from around the state were asked to report when a case or cluster of illness was discovered using the poison control and death record data found within the ESSENCE-FL system.
RESULTS: During the period of May 1 – August 31, 2013, 78 separate events of public health importance were noted in Merlin as having been identified through ESSENCE-FL. A total of 62/78 (79%) of these represent individual reportable diseases/conditions with 16/78 (21%) representing clusters of reportable diseases/conditions. The individual cases identified through ESSENCE-FL included carbon monoxide poisoning, malaria, pertussis, salmonellosis, campylobacteriosis, meningitis, varicella, hepatitis C, and dengue fever. Clusters identified through ESSENCE-FL queries included scombroid poisonings, scabies, carbon monoxide poisonings, and pesticide-related illnesses.
CONCLUSIONS: Syndromic surveillance systems are extremely useful in identifying events of public health importance that may not have been previously reported to the public health authority. By identifying these events rapidly or identifying events that would not have been reported at all, disease control measures are able to be implemented, thus reducing morbidity in Florida. For busy public heath epidemiologists, a standardized, easy-to-use query is paramount to the identification of these events.