Public Health Surveillance for Vancouver 2010 Syndromic y Surveillance Workshop p Ontario Agency for Health Protection and Promotion Toronto – March 30, 2009
Patricia Daly MD, FRCPC Chief Medical Health Officer and Vice-President, Public Health
Vancouver 2010 • Olympic Games: February 12-28, 2010 • Paralympic y p Games: March 12-21, 2010
XXI Olympic Winter Games • 17 days of competition • 5,500 , athletes & officials • 82 nations • 140 ticketed events, 70 medal events
XXI Olympic Winter Games • 10,000 accredited media • 25,000 , volunteers • 1.6 million tickets 70 000 visitors per • 70,000 day, 35,000 overnight visitors
Vancouver XI Paralympic Winter Games • 10 Days of Competition • 1,350 , athletes & officials • 40 countries • 250,000 tickets
Vancouver 2010 • Largest city to host a Winter Olympics • Vancouver, Whistler – major tourist destinations – Health care system has experience with large numbers of visitors
• Vancouver Symphony of Fire: – 1.8 million spectators over 4 nights
Risk Assessment • Experience of previous Olympic Games: – Visit to Turin, Italy in 2006 – Visit and meetings with Salt Lake City representatives (2002 Games) – Review of literature – Meetings with International Olympic Committee Officials
Olympic Athletes – Countries of Origin Turin
100 athletes 50-99 50 99 athletes thl t 10-49 athletes 50% of athletes: United States Switzerland Canada Sweden Italy Japan Russia Norway Germany
Turin Syndromic Surveillance • Established in 3 Olympic Polyclinics and Venue Medical Services – ATOS Origin clinical information system
• Emergency Rooms of 4/12 Olympic hospitals 1 additional hospital hospitals, – All different information systems
• Physician on-call group
Turin Syndromic Surveillance 1. Respiratory syndrome with ith ffever 2. GI syndrome without blood stools 3. Bloody diarrhea 4. Fever with rash 5. Lymphadenitis with fever 6. Neurologic syndrome 7. Acute jaundice 8 Sexually transmitted 8. disease
9. Suspected p influenza 10. Hemorrhagic acute syndrome 11. Peripheral neurologic syndrome 12 Focal lesion 12. 13. Unexplained shock/sepsis 14. Coma 15. Unexplained death 16. None
Turin Syndromic Surveillance • Most common syndromes: 1. Respiratory syndrome with fever 2 Gastroenteritis 2.
• No increase in any syndrome over the reporting ti period i d • Errors in coding • Data not real time
Salt Lake City 2002 • Syndromic surveillance system established – Automated analysis of “Chief Chief complaint” complaint data from ERs
• Of limited value
Olympics – Public Health Issues in P Past Games G • No communicable disease outbreaks • No major health protection issues • Issues I related l t d to t crowding di e.g. iinjuries j i – mitigated by advance planning • Security/terrorist concerns
Vancouver 2010 - Disease and I j Injury Surveillance S ill Goal: To monitor and respond to unusual health events before, during and after the Vancouver 2010 Olympic and Paralympic Games
Surveillance System Components Existing Data:
Data Enhancements:
• •
• Expanded ER data • VANOC Polyclinic/Venue Medical Services encounters • Hotel medical services • Injury surveillance • Illicit drug overdose
• • • • • • • •
Emergency Room data Reportable communicable diseases Laboratory data Facility outbreaks Foodborne illness complaints Sentinel physician surveillance for ILI Poison Control data HLSBC (BC Nurse line) BC Ambulance calls Police calls data
Communication links with key partners
Public Health Surveillance Unit Supporting regional public health practice: – – – –
Health Assessment Disease Surveillance Epidemiological Investigations Knowledge Transfer Public Health Surveillance Unit 8th Floor - 601 West Broadway Vancouver, British Columbia C d V5Z 4C2 Canada
[email protected]
VCH Information Systems • PARIS – Comprehensive community system – Communicable disease reporting and follow followup – Mental health and addictions – Homecare, youth clinics, etc.
• CareConnect - EMR – All acute care systems in VCH – PARIS
Source: BCCDC
Weekly Number of Norovirus Isolates, BC, 2003-2009 40
5 year average (2003-2008)
35 2008-09
30 25 Num ber of 20 isolates 15 10 5
Week
Source: Provincial Laboratory
39
35
31
27
23
19
15
11
7
3
52
48
44
40
0
Suspected Foodborne Illness and d Outbreaks O tb k [2006 - 07] # Monthly Reports: Care Facility Outbreaks v. FBI Complaints Vancouver 40
susp FBI
35
OBK
30 25 20 15 10 5
2006
Facility outbreaks: 45% confirmed norovirus 40% consistent with norovirus 5% other causes
2007
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Medical Services Plan of BC I f ti Infectious Enteric E t i Illness Ill Surveillance S ill I n f e c t i ous Ent e r i c I l l ne ss S ur v e i l l a nc e P i l ot P r oj e c t v 1. 8 A r e a : C LN TLH A 16 1 - Va nc ouv e r - C i t y C e nt r e
C ur r e nt t o : 2 6 M a r 2 0 0 9
003 009 558 - A l l E nt er i cs as P er c ent age of A l l 003-009,
1.2% 1.0% 0.8% 0.6% 0.4% 0.2% 0.0%
N u mb e r o f Se r v i c e s ( A r e a P o p u l a t i o n i s 1 0 4 , 5 8 6 )
40 30 20 10 0 D a i l y C ount s f or M os t R e c e nt 3 0 D a y s
20 15 10 5 0 25 Feb,
26 Feb,
27 Feb,
28 Feb,
2009
2009
2009
2009
1 Mar, 2009 2 Mar, 2009 3 Mar, 2009 4 Mar, 2009 5 Mar, 2009 6 Mar, 2009 7 Mar, 2009 8 Mar, 2009 9 Mar, 2009
10 Mar,
11 Mar,
12 Mar,
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22 Mar,
23 Mar,
24 Mar,
25 Mar,
26 Mar,
2009
2009
2009
2009
2009
2009
2009
2009
2009
2009
2009
2009
2009
2009
2009
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2009
Source: Ministry of Health
Emergency Room Data • 6 Emergency Rooms – All have different information systems
• Analysis of “Chief Complaint” data by PHSU – Of limited li it d value l
• St. Paul’s Hospital – Discharge diagnosis collected in real time – Useful for public health
SPH Homeless Presenting C Complaint l i N = 4213
Data Enhancements • VANOC Polyclinic/Venue Medical Services data – Clinical information system – ATOS Origin – Daily data transfer to VCH for analysis – Diagnostic codes – not syndromes
Data Enhancements • Hotels – VANOC Medical Services at Olympic Family Hotels – Links with other hotels
Data Enhancements • Illicit Drug Overdoses – BC Coroner – Insite (Supervised injection site) – BC Ambulance – St. St Paul’s Hospital
Data Enhancements • BC Nurse Line – 811 – All codes coded by nature of call call, location – Provide phone number in Olympic Visitors’ Guide
Data Enhancements • Injury Surveillance – BC Injury Research and Prevention Unit – ER data – BC Ambulance data – Poison Control – Vancouver Police Department – Injury I j surveillance ill system t a kkey public bli h health lth legacy
Communication Links • VCH – – – –
Physicians Hospitality industry Aboriginal communities Non-governmental organizations
• External Stakeholders – – – – – –
Other Regional Health Authorities – Medical Health Officers Provincial Health Service Authority, including BCCDC Public Health Agency of Canada Health Canada Canadian Forces Medical Services Neighbouring States
Prevention Initiatives – Games Time Ti • Public Health Nurses in Polyclinics – Communicable disease testing and follow-up – Rapid p flu tests, enteric testing, g Point-of-care HIV
• Cluster and outbreak investigation – Public health inspectors in Villages – Laboratory linkages for expedited testing
Health Protection • Food Safety and Quality – HACCP-based inspection back to suppliers – Dailyy venue inspections p during g Games – Enhanced pre-Games inspection of all VCH food service establishments
• Water Quality – Enhanced monitoring and reporting of bacteriological, chemical and physical parameters during Games
• Air Quality – Air Quality Health Index
Public Health Reports • Produced monthly – Broad electronic distribution
• Planning activities, issue identification, surveillance ill d data, t health protection reports
Public Health Reports • Produce daily during the Games – Surveillance report – All reported data – Air and water quality – Weather – Inspection reports – Health promotion activities and awareness
• Distribute to IOC, OC partners and the public • Post to the web