BACKGROUND: Emerging health events like Zika virus present unique surveillance challenges during the early, or acute, phases of those events because the types and volume of data required for public health response change rapidly. The Virginia Department of Health (VDH) adopted a multi-faceted approach to surveillance in order to meet the demands for data collection and reporting. Challenges included data timeliness, completeness and accuracy, the reclassification of cases per new case classifications, and limitations of the surveillance systems.
METHODS: VDH used a combination of Excel, REDCap (Research Electronic Data Capture), ArboNET, and Virginia’s installation of the NEDSS Base System, VEDSS (Virginia Electronic Disease Surveillance System), to assign Zika IDs, capture screening and case information, and report surveillance data to internal and external stakeholders. SAS and STATA programs were used to compare overlapping case data in REDCap and VEDSS, and identify cases that needed reclassification.
RESULTS: Excel and REDCap were used in the acute phase of Zika virus surveillance to assign Zika ID numbers, capture screening data, and report results in graphic and tabular form. These systems were maintained by Central Office staff based on data available through VEDSS, as well as case report forms provided by the localities. Investigation pages in VEDSS were developed using PageBuilder to closely match case report forms, which allowed Central Office staff and localities to enter case data and review electronic lab reports (ELRs). Data from REDCap and VEDSS were entered into ArboNET to report case data to CDC. Over 2,100 persons had Zika-related data captured in both REDCap and VEDSS. Ultimately, the quality assurance efforts needed to ensure consistency between REDCap and VEDSS, stability of investigation tools, plus the availability of ELR data in VEDSS, led to the transition of surveillance almost entirely to VEDSS. Although ArboNET continues to be used to report data to CDC, VDH plans to transition to use of VEDSS for this purpose in 2017.
CONCLUSIONS: VDH’s multi-faceted approach to Zika virus response ensured that the agency had the necessary surveillance data for public health response. REDCap provided the flexibility needed during the most acute phase of the emerging event, as data needs evolved rapidly. The VEDSS system provides a long-term home for case data; accessible by Central Office and local staff. VDH’s experience with Zika helps provides a template for surveillance system use for emerging infections.