Biosurveillance

Biosurveillance means tracking, recording, and sharing information about illness. The White House-issued National Strategy for Biosurveillance(link is external) defines biosurveillances as “gathering, integrating, interpreting, and communicating essential information that might relate to disease activity and threats to human, animal, or plant health.” This functions as the official federal definition.

Nationally, tracking new disease activity and developing initiatives in response to them is the National Biosurveillance Integration Center (NBIC)(link is external), housed within the Department of Homeland Security. In Los Angeles, the county health department tracks emerging illnesses and decides when to term them pandemics.

With regards to disease surveillance systems that function in LA county, there are three main methods of gathering actionable information. The first, and most prominent method, is through laboratory reporting. There are a significant number of laboratories that run medical diagnostic testing throughout LA county and California in general. These laboratories, upon diagnosing a sample with a communicable disease (such as influenza, Measles, Tuberculosis, etc.) are then mandated by state law to send a report to the LA County Public Health department. The system they have in place for this, called eLab Reporting, is an automated system that connects them to the labs directly. While this is the primary method for labs to report, they also have the option to send in reports via mail, fax, or email. The second method, which when combined with laboratory reporting makes up the majority of disease reporting received by the Public Health department, is physician reporting. According to state law, physicians are required to report to the Public Health department any suspected case involving an infectious disease. There is no automated system for physician reporting, instead they use downloading PDF files on the Public Health departments website which the physician can then download, print out, fill out, and either email, fax, or mail back. The physicians are trained to follow the guidelines for a reportable condition, as not every case needs to be reported. Lastly, the third method of gathering information is the Biosense platform. The Biosense platform is a federal syndromic surveillance program that takes data from Emergency Departments across LA county and looks for patterns among the data. The programs initial intent was to quickly alert the government in the event of a bioterrorist event, however in terms of use for day-to-day Public Health activities, the data they get from it is limited. This is due to the nature of syndromic surveillance, which relies on large numbers of cases to cause a blip on Biosense. These three methods, laboratory based reporting, physician reporting, and the Biosense platform, form the main means of gathering actionable information for the LA county Public Health department.

Diseases and conditions that health care providers are mandated to report in Los Angeles County can be found here(link is external).

BioSense 2.0(link is external), maintained by the CDC, is cloud-based aggregation, integration, and analysis of information provided by emergency management departments around the country.

We are building a disease surveillance system at a private high school in Los Angeles. Children and teenagers can be the first warning of emerging illenesses since they, without pre-existing immunity, are often the first to get ill during a pandemic. However there is no standardized system of disease reporting in the United States, in either public or private schools. EPICenter LA is building a model for near real-time reporting via SMS technology, or text messaging, during a bioterror event. Simple coding in to a centralized database will construct a heatmap of spreading illness for rapid response and distribution of needed supplies. We hope to eventually expand the system to all the high schools, public and private, in Los Angeles. We currently have a database of absentee data culled by our partner school’s administration. As the pilot develops, we will employ SMS technology and experiment with other technologies.