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Improving Disaster Surveillance: An Environmental Epidemiology Perspective

Improving Disaster Surveillance: An Environmental Epidemiology Perspective. Lauren Lewis, MD, MPH. Health Studies Branch Environmental Hazards and Health Effects National Center for Environmental Health Centers for Disease Control and Prevention.

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Improving Disaster Surveillance: An Environmental Epidemiology Perspective

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  1. Improving Disaster Surveillance: An Environmental Epidemiology Perspective Lauren Lewis, MD, MPH Health Studies Branch Environmental Hazards and Health Effects National Center for Environmental Health Centers for Disease Control and Prevention

  2. Health Studies Branch(HSB)Disaster Epidemiology and Response • Types of disasters • Natural (extreme weather events) • Technological (chemical and radiologic events) • Complex emergencies • Focus: epidemiologic support to state and local public health • Accurate data for public health decision-making

  3. Deepwater Horizon Oil Spill National Heat Wave 2012 Hurricane Sandy 2012 American Samoa Tsunami

  4. Types of Epidemiologic Activities • Public health surveillance • Track illness, injury and death • Identify outbreaks • Syndromic, laboratory, morbidity, mortality • Rapid needs assessments • Identify shelter, community and health care needs to allocate resources • CASPER • Program evaluations • Assess success and identify barriers to improve response efforts • Epidemiologic research • Identify risk/protective factors for injury , illness and death • Case-control, cohort, outbreak investigations, case series

  5. Utility of Epidemiologic Data Epidemiologic research Surveillance # deaths and illnesses, identify vulnerable pop or acute threats Identify risk and protective factors Program evaluations Rapid needs assessments Estimate unmet infrastructure and health care needs Evaluate interventions

  6. Why Conduct Disaster Surveillance? • Provide situational awareness • Track morbidity and mortality • Detect disease outbreaks • Determine action items such as resource allocation • Target interventions • Facilitate future disaster planning

  7. Data Flow • Mortality • ME/coroners • Hospitals • Nursing home • Funeral home • DMORT office • ARC • Morbidity • Hospitals • Clinics • Shelters • Service delivery • sites Data Data • Public Health • County • Region • State Other States Report CDC Emergency Operations/ IMS

  8. Current HSB Disaster Surveillance Activities • Build capacity • Provide surveillance tools and training • Provide technical assistance during disasters • Conduct surveillance • Partner with American Red Cross (ARC) and poison centers • Utilize National Poison Data System (NPDS) • Analyze data and disseminate findings • Evaluate surveillance efforts

  9. Provide Surveillance Tools and Training • Provide standardized disaster surveillance forms • Includes morbidity and mortality • Modifiable for any type of disaster • Available at http://www.bt.cdc.gov/disasters/surveillance • Conduct disaster epidemiology training • Includes surveillance and CASPER

  10. Conduct Surveillance with American Red Cross • Monitor and analyze ARC mortality reports • Facilitate morbidity surveillance in ARC shelters

  11. Conduct Poison Center Surveillance • National Poison Data System (NPDS) • Monitors calls to poison centers from clinicians and the public • Provides national, near real-time surveillance data • Poison center utility during disasters • Track CO poisonings • Monitor public concern • Provide hotline support

  12. Radiologic Disaster Surveillance • Enhanced NPDS to detect and monitor radiologic events • Developed a standardized data collection tool • Collect data at community reception centers • Multipurpose: surveillance, acute triage, and long-term follow-up • Available at www.emergency.cdc.gov/radiation/crc/vcrc.asp • Exploring strategies to improve screening capacity

  13. Disaster Surveillance Challenges • Absent baseline information • Denominator data difficult to obtain • Damaged healthcare infrastructure • Need for rapid information

  14. Disaster Surveillance Challenges • Competing priorities • Data collection varies between states and events • No incentive to share data with CDC • No electronic mechanism for data sharing

  15. Potential Strategies to Improve Disaster Surveillance • Develop surveillance guidance • Increase utilization of existing surveillance during disasters • Biosense, National Poison Data System (NPDS), American Red Cross data, Environmental Public Health Tracking (EPHT), State-based syndromic surveillance, NCHS mortality data • Explore the utility of nontraditional sources • Track internet and social media reports • Active mortality surveillance

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