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BACKGROUND: Children <5 are at increased risk for morbidity and mortality from influenza infection. Hospitalizations for influenza in children <5 are not currently reportable in Florida. Discharge data on children with influenza infection are available, but only after long delays (3-9 months) through the Florida Agency for Healthcare Administration (AHCA) hospital discharge dataset. This delay hinders timely evidence-based decision-making during influenza season about health promotion to an at-risk sub-population. This investigation determines if Florida’s syndromic surveillance system (ESSENCE-FL) could monitor influenza infection in children <5 in a timely manner by comparing historical records of visits for influenza and influenza-like-illness (ILI) to historical hospital discharge AHCA records of children <5 admitted to hospital or visiting the Emergency Department (ED) with diagnosed influenza. Hospital discharge data includes all hospital admissions and ED visits, data that is required to be sent by all facilities, and is considered comprehensive. Previous evaluations determined that most (99%) admissions for influenza are through the ED.
METHODS: Florida AHCA data for ED visits and hospitalizations from 2008-2014 were queried for children <5 diagnosed with influenza (ICD9-CM Code: 487 or 488). ESSENCE-FL was queried for hospital visits from 2008-2014 to children <5 with “influenza” listed in their chief complaints and were categorized as having ILI or influenza. The data was compared to identify the query that best approximated the hospital discharge data.
RESULTS: In the ACHA data set, 71,807 children <5 were identified who visited EDs or were admitted to Florida hospitals for influenza. In the syndromic surveillance data, 288,033 visits from children <5 to EDs and urgent care centers (UCC) were captured in the ILI syndrome and 25,858 visits from children <5 to EDs and UCCs were captured in the influenza sub-syndrome. While the number of ED visits for influenza were overall underestimated using the ESSENCE-FL sub-syndrome, analysis showed that ED visits for children <5 captured by the influenza sub-syndrome most closely approximated the overall season trend (onset, duration, and end) of children diagnosed with influenza recorded in the ACHA hospital discharge dataset.
CONCLUSIONS: ESSENCE-FL can be used to effectively monitor influenza activity in children <5 in Florida. While rich, complete AHCA data is delayed, which thwarts efforts for timely informed decision-making. States can use syndromic surveillance systems to quickly identify increasing activity and improve messaging to the public. Further research will examine how syndromic surveillance data can be used for timely monitoring influenza-associated admissions in high risk sub-populations.