@article{Munroe_Straver_Rubino_Pritchard_Atrubin_Hamilton_2017, title={MERS PUI Surveillance and Restrospective Identification in ESSENCE-FL, 2013-2015}, volume={9}, url={https://ojphi.org/ojs/index.php/ojphi/article/view/7696}, DOI={10.5210/ojphi.v9i1.7696}, abstractNote={<div style="left: 78.2727px; top: 296.356px; font-size: 12.3207px; font-family: sans-serif; transform: scaleX(1.0823);" data-canvas-width="55.467823232323234">Objective</div><div style="left: 91.3182px; top: 309.359px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00485);" data-canvas-width="331.3654166666665">To retrospectively identify initial emergency department (ED)</div><div style="left: 78.2727px; top: 323.854px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.02852);" data-canvas-width="345.05249015151526">and urgent care center (UCC) visits for Florida’s Middle East</div><div style="left: 78.2727px; top: 338.349px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.01469);" data-canvas-width="344.7235272727272">respiratory syndrome coronavirus disease (MERS-CoV) patients</div><div style="left: 78.2727px; top: 352.844px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.98504);" data-canvas-width="344.1074919191921">under investigation (PUIs) in the Florida Department of Health’s</div><div style="left: 78.2727px; top: 367.339px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.03372);" data-canvas-width="343.35100050505037">(DOH) syndromic surveillance system, the Electronic Surveillance</div><div style="left: 78.2727px; top: 381.834px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.972227);" data-canvas-width="343.60111085858586">System for the Early Notification of Community-based Epidemics</div><div style="left: 78.2727px; top: 396.329px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.970917);" data-canvas-width="343.46188686868686">(ESSENCE-FL), using information gathered from PUI case report</div><div style="left: 78.2727px; top: 410.824px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.06125);" data-canvas-width="346.0726446969696">forms and corresponding medical records for the purpose of</div><div style="left: 78.2727px; top: 425.319px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.981235);" data-canvas-width="343.56291666666664">improving syndromic surveillance for MERS-CoV. The results of</div><div style="left: 78.2727px; top: 439.814px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.01869);" data-canvas-width="342.72264444444437">this study may be further utilized in an effort to evaluate the current</div><div style="left: 78.2727px; top: 454.309px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00637);" data-canvas-width="160.83451010101015">MERS-CoV surveillance query.</div><div style="left: 78.2727px; top: 481.892px; font-size: 12.3207px; font-family: sans-serif; transform: scaleX(1.11884);" data-canvas-width="71.86668434343434">Introduction</div><div style="left: 91.3182px; top: 494.895px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.968126);" data-canvas-width="328.42076767676764">Human MERS-CoV was first reported in September 2012. Globally,</div><div style="left: 78.2727px; top: 509.39px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.02155);" data-canvas-width="342.8507797979797">all reported cases have been linked through travel to or residence in</div><div style="left: 78.2727px; top: 523.884px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00267);" data-canvas-width="342.32838181818175">the Arabian Peninsula with the exception of cases associated with an</div><div style="left: 78.2727px; top: 538.379px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.02673);" data-canvas-width="343.167421969697">outbreak involving multiple health care facilities in the Republic of</div><div style="left: 78.2727px; top: 552.874px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.01042);" data-canvas-width="342.56740353535355">Korea ending in July 2015. While the majority of MERS-CoV cases</div><div style="left: 78.2727px; top: 567.369px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.995049);" data-canvas-width="342.0979845959596">have been reported in the Arabian Peninsula, several cases have been</div><div style="left: 78.2727px; top: 581.864px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.01595);" data-canvas-width="342.7127878787879">reported outside of the region. Most cases are believed to have been</div><div style="left: 78.2727px; top: 596.359px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00919);" data-canvas-width="342.50087171717166">acquired in the Middle East and then exported elsewhere, with no or</div><div style="left: 78.2727px; top: 610.854px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.0202);" data-canvas-width="342.88897398989894">rare instances of secondary transmission. Two cases of MERS-CoV</div><div style="left: 78.2727px; top: 625.349px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.02023);" data-canvas-width="342.7633027777777">were exported to the United States and identified in May 2014. One</div><div style="left: 78.2727px; top: 639.844px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00125);" data-canvas-width="259.7081843434343">of these cases traveled from Saudi Arabia to Florida.</div><div style="left: 91.3182px; top: 668.834px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.963814);" data-canvas-width="330.10624040404036">DOH conducts regular surveillance for MERS-CoV through the</div><div style="left: 78.2727px; top: 683.329px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.967228);" data-canvas-width="343.5111696969697">investigation of persons with known risk factors. PUIs have most</div><div style="left: 78.2727px; top: 697.824px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.01939);" data-canvas-width="342.80519318181825">often been identified by physicians reporting directly to local health</div><div style="left: 78.2727px; top: 712.319px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.992348);" data-canvas-width="341.9797058080809">departments and by DOH staff regularly querying ED and UCC chief</div><div style="left: 78.2727px; top: 726.814px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.03119);" data-canvas-width="343.21547272727224">complaint data in ESSENCE-FL. ESSENCE-FL currently captures</div><div style="left: 78.2727px; top: 741.309px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.985104);" data-canvas-width="344.17895202020196">data from 265 EDs and UCCs statewide and has been useful in</div><div style="left: 78.2727px; top: 755.804px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.978429);" data-canvas-width="343.5752373737374">identifying cases associated with reportable disease and emerging</div><div style="left: 78.2727px; top: 770.299px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00171);" data-canvas-width="53.04064393939394">pathogens.</div><div style="left: 78.2727px; top: 797.882px; font-size: 12.3207px; font-family: sans-serif; transform: scaleX(1.07424);" data-canvas-width="50.65042676767676">Methods</div><div style="left: 91.3182px; top: 810.884px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.972054);" data-canvas-width="330.25532095959613">From 2013-2015 DOH identified and investigated 62 suspected</div><div style="left: 78.2727px; top: 825.379px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.966515);" data-canvas-width="343.4027474747477">cases of MERS-CoV, including one confirmed case in May 2014.</div><div style="left: 78.2727px; top: 839.874px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.966311);" data-canvas-width="343.50747348484845">Specimens were collected from all 62 patients under investigation</div><div style="left: 78.2727px; top: 854.369px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.04578);" data-canvas-width="343.1193712121213">(PUIs) and 61 were ruled out. Of the 61 PUIs who were ruled out,</div><div style="left: 78.2727px; top: 868.864px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.991358);" data-canvas-width="344.2984628787878">ten were part of the contact investigation initiated following the</div><div style="left: 78.2727px; top: 883.359px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.02017);" data-canvas-width="342.75960656565655">identification of MERS-CoV in May 2014 and were not included in</div><div style="left: 78.2727px; top: 897.854px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.952331);" data-canvas-width="343.4581906565656">this analysis. DOH utilizes a MERS-CoV PUI case report form to</div><div style="left: 78.2727px; top: 912.349px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.03008);" data-canvas-width="342.8433873737375">collect data regarding demographics, clinical presentation, and risk</div><div style="left: 78.2727px; top: 926.844px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00976);" data-canvas-width="344.2762856060606">factors. Retrospectively, additional documents including medical</div><div style="left: 78.2727px; top: 941.339px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.01359);" data-canvas-width="344.85659090909076">records and discharge summaries were gathered and utilized to</div><div style="left: 78.2727px; top: 955.834px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.0048);" data-canvas-width="209.78467929292933">evaluate PUIs identified in ESSENCE-FL.</div><div style="left: 91.3182px; top: 984.824px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.01061);" data-canvas-width="329.49266919191916">Name of the facility where PUIs presented, date and time of visit,</div><div style="left: 78.2727px; top: 999.319px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.994757);" data-canvas-width="342.01420378787884">age at event, and sex were identified using PUI case report forms and</div><div style="left: 78.2727px; top: 1013.81px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.986223);" data-canvas-width="341.80844797979796">corresponding medical records and discharge summaries. Visit details</div><div style="left: 78.2727px; top: 1028.31px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.968658);" data-canvas-width="343.6959803030303">for each of the identified facilities were queried in ESSENCE-FL</div><div style="left: 78.2727px; top: 1042.8px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.02465);" data-canvas-width="342.84831565656543">and pulled for all visits with corresponding age at event and sex for</div><div style="left: 78.2727px; top: 1057.3px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.03728);" data-canvas-width="343.13169191919206">the patient’s visit date. Additional PUI information including chief</div><div style="left: 443.545px; top: 294.864px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.04171);" data-canvas-width="343.27830833333314">complaint, discharge diagnosis, ZIP code, race, and ethnicity were</div><div style="left: 443.545px; top: 309.359px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.02881);" data-canvas-width="343.1427805555555">gathered for the purpose of matching corresponding ESSENCE-FL</div><div style="left: 443.545px; top: 323.854px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.981874);" data-canvas-width="341.5940676767676">data fields. ESSENCE-FL visit details were narrowed by ZIP code (or</div><div style="left: 443.545px; top: 338.349px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.03281);" data-canvas-width="343.0984260101007">lack of ZIP code for residents of other countries) and match details</div><div style="left: 443.545px; top: 352.844px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.02894);" data-canvas-width="342.84215530303027">were recorded and evaluated. The fields examined were not always</div><div style="left: 443.545px; top: 367.339px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.0015);" data-canvas-width="342.19531818181815">complete in ESSENCE-FL. Visits were considered matches when all</div><div style="left: 443.545px; top: 381.834px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.982558);" data-canvas-width="341.83185732323227">available data in the fields examined were consistent with information</div><div style="left: 443.545px; top: 396.329px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.03173);" data-canvas-width="343.0836411616164">obtained in the PUI case report form and available medical records</div><div style="left: 443.545px; top: 410.824px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00312);" data-canvas-width="127.63020454545456">and discharge summaries.</div><div style="left: 443.545px; top: 438.407px; font-size: 12.3207px; font-family: sans-serif; transform: scaleX(1.08542);" data-canvas-width="44.50239393939395">Results</div><div style="left: 456.591px; top: 451.41px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.98271);" data-canvas-width="330.89476565656554">Of the 52 PUIs included in this analysis, 39 sought treatment</div><div style="left: 443.545px; top: 465.905px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00068);" data-canvas-width="344.4500075757577">at facilities participating in ESSENCE-FL at their time of visit.</div><div style="left: 443.545px; top: 480.4px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.999018);" data-canvas-width="344.1949689393939">Comparing information obtained from PUI documents with data</div><div style="left: 443.545px; top: 494.895px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.01987);" data-canvas-width="342.9468813131311">provided in ESSENCE-FL, 30 ED visits were successfully matched</div><div style="left: 443.545px; top: 509.39px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00137);" data-canvas-width="342.23351237373737">to PUIs, including an initial ED visit for the patient with a confirmed</div><div style="left: 443.545px; top: 523.884px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.01718);" data-canvas-width="101.63351262626263">case of MERS-CoV.</div><div style="left: 443.545px; top: 551.467px; font-size: 12.3207px; font-family: sans-serif; transform: scaleX(1.10408);" data-canvas-width="73.93656313131314">Conclusions</div><div style="left: 456.591px; top: 564.47px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.05988);" data-canvas-width="332.9264502525252">Following preliminary identification, all matches are to be</div><div style="left: 443.545px; top: 578.965px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.993609);" data-canvas-width="341.9341191919193">confirmed with the appropriate hospitals. Future work to examine the</div><div style="left: 443.545px; top: 593.46px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.01158);" data-canvas-width="342.58711666666676">chief complaints associated with patients’ initial ED visits identified</div><div style="left: 443.545px; top: 607.955px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.03494);" data-canvas-width="343.0996580808075">in ESSENCE-FL will serve as a way to validate and improve upon</div><div style="left: 443.545px; top: 622.45px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.999482);" data-canvas-width="342.0560941919192">the query currently being used as a surveillance tool for MERS-CoV.</div><div style="left: 443.545px; top: 636.945px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.987304);" data-canvas-width="344.2565724747474">Detailing these methods also has value in the replication of this</div><div style="left: 443.545px; top: 651.44px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.961353);" data-canvas-width="343.74772727272745">study for other diseases and in the development and validation of</div><div style="left: 443.545px; top: 665.935px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.968326);" data-canvas-width="343.20684823232307">other disease-specific queries. Summarizing the reasons why PUIs</div><div style="left: 443.545px; top: 680.43px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.03434);" data-canvas-width="342.9000626262626">were unable to be matched to ESSENCE-FL visits is also useful in</div><div style="left: 443.545px; top: 694.925px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00165);" data-canvas-width="146.82586616161615">improving system robustness.</div>}, number={1}, journal={Online Journal of Public Health Informatics}, author={Munroe, Julia and Straver, Rachael and Rubino, Heather and Pritchard, Scott and Atrubin, David and Hamilton, Janet J.}, year={2017}, month={May} }