Erasing the Border – Syndromic Surveillance for Mass Gatherings Across State Lines

BACKGROUND:  Both Pennsylvania and New Jersey utilize Health Monitoring’s (HMS) EpiCenter platform for syndromic surveillance of emergency departments (ED) visits. Use of the same system by both jurisdictions provided an opportunity to explore interstate data sharing during two recent mass gathering events, the World Meeting of Families/Papal Visit (WMF/PV) in late September 2015 and the Democratic National Convention (DNC) in July of 2016. The Philadelphia Department of Public Health (PDPH) Division of Disease Control served as the lead agency for surveillance planning, with representatives participating from the Pennsylvania Department of Health (PADOH), the New Jersey Department of Health (NJDOH), HMS and surrounding county health departments expected to be impacted.

METHODS: As part of the emergency response planning process for the City of Philadelphia and the states of Pennsylvania and New Jersey, surveillance staff worked with HMS to determine how best to monitor ED visits in Philadelphia and the surrounding counties during a large event. Surveillance strategies developed for previous mass gathering events in Florida, Arizona, and New Jersey provided a basis for the surveillance approach used for the WMF/PV and DNC. In particular, initiatives employed by NJDOH during Super Bowl 48 seeded our cross-border reporting and data sharing syndromic surveillance strategies for these more recent events. These included:

• Transmission of reports and data in intervals. Information included:
  • Occurrence of event-related keywords
  • Identification of “out of jurisdiction” patient zip codes with baseline comparison
  • Repeated use of new or uncommon chief complaint vocabulary
  • Identification of immediately notifiable conditions

The cross-jurisdictional nature of the WMF/PV and the DNC surveillance required written consensual agreement signed by both states. It also required the creation of surveillance cross-border regions within Epicenter for each event, which was the main unit of geography for our reports and analysis.

RESULTS: During the periods around both events, reports allowed surveillance staff from all jurisdictions to have an extensive overview of ED visit activities from the WMF/PV and DNC regions and provided information for sharing with emergency preparedness and public health partners in all jurisdictions.

CONCLUSIONS: While no events of concern occurred during the two enhanced surveillance periods, participating agencies were able to access information regarding ED visit trends before, during and after the events. The process allowed for immediate action to be taken against potential public health threats and ultimately laid important groundwork for future data sharing.