Syndromic surveillance: a public health legacy of the London 2012 Olympic and Paralympic Games
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1 Syndromic surveillance: a public health legacy of the London 2012 Olympic and Paralympic Games Dr Alex Elliot Project Lead, PHE Real-time Syndromic Surveillance Team
2 Conflict of interest I hold no conflicts of interest with respect to: Any direct financial interest in or personal relationship with a commercial entity ( the Organization ) Share ownership or investments held in the Organization Membership in the Organization s advisory board or other committees Member of a speakers bureau 2 Syndromic Surveillance of Health and Climate-Related Impacts: Ontario, 17 March 2014
3 3 Syndromic surveillance during the London 2012 Olympic and Paralympic Games
4 Real-time Syndromic Surveillance Team (ReSST) Information for public health action early warning situational awareness reassurance Based in Birmingham but delivering a national service Gaining national and international reputation 4 Cold Syndromic Weather Surveillance Seminar 1st of July Health 2013 and Climate-Related Impacts: Ontario, 17 March 2014 PHE Syndromic Surveillance Service
5 5 Syndromic Surveillance of Health and Climate-Related Impacts: Ontario, 17 March 2014
6 General features of syndromic surveillance systems No additional requirements for clinicians Automated data capture/transfer Data available near real-time Provide early warning Statistical alarms to alert to unusual activity Population-based 6 Syndromic Flexible Surveillance response of Health and Climate-Related Impacts: Ontario, 17 March 2014
7 Current PHE syndromic system data sources Sentinel GP (RCGP) OTC sales Tele-health (NHS 111) Social media (Twitter) GP in hours ReSST Emergency department Ambulance HCW absenteeism Web activity GP out of hours 7 FES Scientific Meeting - 3 March 2014
8 "The International Olympic Committee has the honour of announcing the games of the 30th Olympiad in 2012 are awarded to the city of London." 8
9 Pre-Olympics Preparing for the Olympics Participating in the Olympics Post-Olympic legacy 9 Syndromic Surveillance of Health and Climate-Related Impacts: Ontario, 17 March 2014
10 Pre-Olympics NHS Direct Tele-health system QSurveillance General practitioner (GP) system 10 Syndromic Surveillance of Health and Climate-Related Impacts: Ontario, 17 March 2014
11 Respiratory infections: seasonal surveillance 11 Syndromic Surveillance of Health and Climate-Related Impacts: Ontario, 17 March 2014
12 Thresholds for public health action NHS Direct Syndromic Dashboard 12 Syndromic Surveillance of Health and Climate-Related Impacts: Ontario, 17 March 2014
13 Influenza-like illness 250 Influenza like illness rate per population in the UK All patients all ages regional + age group Week (Database version 1) Copyright QRESEARCH 2011 Data source: QSurveillance (weekly data) - 28 Feb 2011 UK UK Syndromic Surveillance of Health and Climate-Related Impacts: Ontario, 17 March 2014
14 14 Syndromic Surveillance of Health and Climate-Related Impacts: Ontario, 17 March 2014
15
16 London 2012 Games: in numbers 8 million Olympics tickets available 2 million Paralympics tickets 900,000 daily spectators & volunteers 400,000 (Para)Olympians, teams, workers, officials, volunteers, media 250,000 accredited people 20,000 accredited media 128 heads of state, royalty, VIPs etc 0.9M 2.8M overnight visitors to London 88% - Olympic traffic will arrive via Heathrow 16 Syndromic Surveillance of Health and Climate-Related Impacts: Ontario, 17 March 2014
17 Olympic preparations 17 Syndromic Surveillance of Health and Climate-Related Impacts: Ontario, 17 March 2014
18 Enhanced syndromic surveillance New syndromic surveillance systems New statistical monitoring systems Strengthen interpretation and analysis of positive signals Standardise the reporting of alarms Assess the limitations of the systems 18 Syndromic Surveillance of Health and Climate-Related Impacts: Ontario, 17 March 2014
19 ED surveillance: why? Changes in population dynamics during Games Overseas visitors (limited access to NHSD + GP) Ability to monitor more severe infection e.g. SARS Changes in UK health care usage Emergency Department Syndromic Surveillance System (EDSSS) 19 Syndromic Surveillance of Health and Climate-Related Impacts: Ontario, 17 March 2014
20 ED daily ARI attendances 20 Syndromic Surveillance of Health and Climate-Related Impacts: Ontario, 17 March 2014
21 Injury data through EDSSS Cold weather surveillance (forearm/wrist/femur fractures in females) 21
22 GP out-of-hours Different case mix to in hours GPs More acute rather than chronic management Routine daily Weekend/bank holiday coverage 22 Syndromic Surveillance of Health and Climate-Related Impacts: Ontario, 17 March 2014
23 GP out-of-hours Source: Adastra Software Ltd 23 Syndromic Surveillance of Health and Climate-Related Impacts: Ontario, 17 March 2014
24 Olympic countdown: Day 0 24 Syndromic Surveillance of Health and Climate-Related Impacts: Ontario, 17 March 2014
25 The Olympic difference Enhanced business as normal Fine tooth comb/no stone left unturned Reassurance of lack of impact of incidents on health ReSST Olympic commitments: Provision of an enhanced daily service Daily Olympic bulletin Providing large part of national SitRep Cabinet Office/COBRA Improved statistics for each system World media spotlight on the UK/PHE 25 Syndromic Surveillance of Health and Climate-Related Impacts: Ontario, 17 March 2014
26 Daily reporting April to June (weekdays) Daily reporting July to Sept ReSST working shifts to cover 7 day/week reporting Messages/data inserted into HPA national daily SitRep LOCOG/DH/COBRA Tight deadlines each day Daily Olympics reporting 26 Syndromic Surveillance of Health and Climate-Related Impacts: Ontario, 17 March 2014
27 Daily Olympics reporting: summary statistics 27 Syndromic Surveillance of Health and Climate-Related Impacts: Ontario, 17 March 2014
28 Alarms to alerts Standardising the response to alarms Risk assessment process for prioritising statistical alarms Definitions: Signal a test statistic, e.g. number of cold/flu calls to NHS Direct in London, with an associated alarm Alarm when a test statistic significantly exceeds its expected value Investigation the process by which the ReSST investigate the alarm to determine whether it has the characteristics that would warrant further public health action Alert notification of unusual activity from the ReSST team to the rest of HPA or externally Improves the public health action Provides an audit trail of decisions 28 Syndromic Surveillance of Health and Climate-Related Impacts: Ontario, 17 March 2014
29 Risk assessment of syndromic alarms Size of the excess? 1/2/3 Is the alarm a repeat? 1/2 Is the rise unusual for time of year? 1/2 Multi-system alarm? 1/3 Score (total) >7 <7 Syndrome? 1/2 Geography? 1/2 Severity? 1/2 Score Final Score (total) >12 <12 Document and review next day Document and review next day Alert and document actions 29 Syndromic Surveillance of Health and Climate-Related Impacts: Ontario, 17 March 2014
30 30 Syndromic Surveillance of Health and Climate-Related Impacts: Ontario, 17 March 2014 Olympic results
31 Olympic results National increase in asthma reassurance Heat wave surveillance 31 Syndromic Surveillance of Health and Climate-Related Impacts: Ontario, 17 March 2014
32 Summary Syndromic surveillance growing in stature internationally Systems more flexible and able to respond to a variety of public health incidents Able to provide reassurance during Olympics PHE syndromic surveillance service and links with PH action unique ReSST developing forward 3 year PHE strategy including supporting other mass gatherings 2012 Olympics provided a huge challenge, but also a massive opportunity to enhance existing programme Legacy, legacy, legacy 32 Syndromic Surveillance of Health and Climate-Related Impacts: Ontario, 17 March 2014
33 Olympic legacy New systems continue to support routine surveillance (ED & OOH) Improved statistics Alarm risk assessment Expanded team Experience to share with other nations hosting mass gatherings 33 Syndromic Surveillance of Health and Climate-Related Impacts: Ontario, 17 March 2014
34 Co-authors/collaborators PHE Real-time Syndromic Surveillance Team: Amardeep Bains, Leandro Carrhilo, Obaghe Edeghere, Sue Ibbotson, Sally Harcourt, Helen Hughes, Paul Loveridge, Roger Morbey, Steve Raven, Gillian Smith, Sue Smith, Trudy Stirzaker Syndromic surveillance data providers: NHS Direct College of Emergency Medicine; Ascribe Ltd; L2S2 Ltd Advanced Health and Care TPP, ResearchOne and the SystmOne GP practices; University of Nottingham, ClinRisk, EMIS and EMIS practices 34 Syndromic Surveillance of Health and Climate-Related Impacts: Ontario, 17 March 2014
35 Thank you Questions? 35 Syndromic Surveillance of Health and Climate-Related Impacts: Ontario, 17 March 2014
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