BACKGROUND: In Connecticut diseases are reportable to both the state (Department of Public Health; DPH) and local public health departments (LHDs). Connecticut is an Emerging Infections Program (EIP) site coordinated by DPH with the Yale School of Public Health (Yale EIP) adding additional responsibilities for tracking of emerging infections and foodborne illnesses. Connecticut is one of several jurisdictions (e.g., MA, NYC, NC, MN and SD) using the Maven application to support these activities. In 2008, DPH acquired Maven to establish the Connecticut Electronic Disease and Surveillance System (CTEDSS). CTEDSS forms the backbone of DPH integrated surveillance (for all reportable diseases except HIV and blood lead), is the primary repository for electronic laboratory reporting (ELR), and supports all DPH Infectious Disease (ID) programs, including the Epidemiology and EIP Programs.
METHODS: CTEDSS was customized to support ID programs’ work. Costs were gradually shifted from paying the vendor exclusively for changes to training three Epidemiology-based staff to configure CTEDSS, including one staff to do more complex coding.
RESULTS: Once CTEDSS staff were trained, additional CTEDSS functionality has been added rapidly since initial production in 2010. In 2011, foodborne illness and outbreak follow up was operationalized in CTEDSS, including real-time data sharing between Yale EIP and LHD partners and direct entry of lab results by the DPH Public Health Laboratory (PHL). For example, in 2016, 1499 enteric cases (9 pathogens) were identified, with 81% having interviews completed by Yale EIP or LHDs by direct data entry into CTEDSS. In 2013, CTEDSS was quickly modified to support Ebola traveler monitoring of 179 persons including all risk assessment and daily temperature monitoring by DPH and LHDs, and in 2016, surveillance for Zika infection in 1910 persons (as of 12/28/16) including receiving lab results via ELR from the PHL and followup on 40 positive pregnant women. CTEDSS has over 300 active users from DPH, Yale EIP, PHL, 64 LHDs, and 30 hospitals. In 2017, changes in CTEDSS will include STD, CRE and expanded EIP surveillance, and new CDC case notification messaging.
CONCLUSIONS: DPH has faced many challenges in establishing an integrated surveillance system, including a lack of state funding and limited internal IT capacity. CTEDSS is 90% funded under federal cooperative agreements. The ability to support CTEDSS primarily with Epidemiology program staff has been critical for DPH to maintain an integrated surveillance system, respond to newly emerging diseases, and move forward with critical electronic data exchange activities.