Josiah Brown Poster Abstract

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Jairo M. Garcia
Dr. Prabhu Gounder, Dr. Shobita Rajagopalan
Prabhu Gounder
Evaluation of the Los Angeles County Department of Public Health’s Influenza Surveillance Using the CDC Guidelines for Effective Surveillance Systems
STTP

Background
Approximately 5-20% of the Los Angeles county population is expected to be infected with influenza. Accurate measures of influenza-related health events are not possible due to variability in clinical practices of diagnostics, mandates of reporting, behaviors in seeking treatment, and variability of symptom severity. Yet, due to the high disease burden in susceptible groups such as children, elderly and immunocompromised, seasonal influenza should be monitored to prepare healthcare personnel (HCP) for increased flu activity. The Los Angeles County Department of Public Health (LACDPH) has established a surveillance program that monitors various aspects of flu epidemiology. These findings are then disseminated in bi-weekly influenza activity reports for health providers and public health organizations may use this data for infection control and action. Like with all surveillance systems, it is necessary evaluate the LACDPH influenza surveillance system’s efficacy using the Center for Disease Control and Prevention (CDC) guidelines on the evaluations of public health surveillance systems. Effective surveillance systems are measured on their degree of integration into health information systems, the feasibility of access and utilization of gathered data by various stakeholders, and the relevance of data in the prevention and mobilization of efforts against outbreaks.

Specific Aims

1) evaluate the accessibility and applicability of the gathered data and reports for the identified stakeholders, 2) gauge the representativeness and geographical distribution of the reported incidences in Los Angeles, and 3) the impacts that the system has had on the incidences of outbreaks, deaths, and the reporting of cases of influenza and influenza-like illnesses.

Objective: Provide appropriate recommendations in areas that show needed improvements and build upon areas of strengths that may provide better recommendations and allocation of resources.

Methods

Direct interviews with stakeholders and those involved with data collection in the Department of Public Health’s influenza surveillance system. Individuals were chosen based on amount of Full-Time Employment dedicated to various aspects of the surveillance system activities of influenza.

Interviews were guiding using the Center for Disease Control and Prevention guidelines on the evaluations of public health surveillance systems. Questions and goals were modified to accommodate the specific aims of communicable diseases and influenza surveillance.

Review of internal documents, protocols, data storage software, previously published influenza season reports. Literature search was another tool to identify previous recommendations on influenza surveillance systems in other jurisdictions. Previously reported Flu Watch reports from LAC, San Diego county, Kaiser of southern California were reviewed to identify varying quality and type of shared information between jurisdictions.  

Results

  1. The influenza surveillance program is very accessible to participating HCP and entities.
  2. The surveillance methods are passive and provide less barriers of reporting for the participating laboratories and facilities.
  3. Personnel required to maintain data collection, analysis and the dissemination are met but are susceptible to delays with a significant increase in influenza activity. Limited ability to cross-reference positive cases under the scope of other systems. The cost and time required to maintain influenza surveillance are kept low without additional funding.
  4. The disseminated influenza reports are accessible to HCP and the public with no significant actions or requirements to obtain reports. The data shared is relevant to standard influenza surveillance systems. There is a need for more data collection to provide social and geographic understandings of flu activity, such as vaccination status, anti-viral treatments, hospitalizations, population demographics, and geographic representation of influenza-related events.
  5. There is limited data on the demographics of laboratory-confirmed flu incidences, OB investigations, vaccination status, and anti-viral therapy information to elucidate any potential health disparities.
  6. While some aspects of influenza incidences are legally mandated, others are not leading to variability in participation and/or quality. Most components have a sufficient level of acceptability in participation and quality of data.
  7. Not enough data on vaccination coverage and anti-viral therapy to assess the impacts that the program has had on improving their usage through health officer orders, public education, and on-site training to skilled nursing settings.

Recommendations

  1. Improve outbreak detection by cross-referencing positive electronic laboratory reports of influenza with skilled nursing facility addresses
  2. Improve detection of influenza-associated deaths by cross-referencing positive electronic laboratory reports of influenza with death certificate data
  3. Track percentage of all hospitalization and deaths that are attributable to either pneumonia or influenza to obtain a more comprehensive assessment of influenza burden
  4. Establish collaborations with community partners, such as Kaiser Permanente, to get real-time data on the burden of influenza on health systems (such as hospitalizations for pneumonia and influenza), get better data on vaccine coverage, and get data on race/ethnicity disparities.
  5. Publish more data on social demographics, if any, and possible underlying social determinants of influenza-related events
  6. Have surge staff present during peak influenza season to avoid delays in reports.
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