@article{Jagger_Jaramillo_Boyd_Johnson_Reed_Powell_2017, title={Mass Gathering Surveillance: New ESSENCE Report and Collaboration Win Gold in OR}, volume={9}, url={https://ojphi.org/ojs/index.php/ojphi/article/view/7719}, DOI={10.5210/ojphi.v9i1.7719}, abstractNote={<div style="left: 86.4px; top: 327.128px; font-size: 13.6px; font-family: sans-serif; transform: scaleX(1.08175);" data-canvas-width="61.227199999999996">Objective</div><div style="left: 100.8px; top: 341.481px; font-size: 13.6px; font-family: serif; transform: scaleX(1.00058);" data-canvas-width="363.2764000000001">To streamline production of a daily epidemiology report including</div><div style="left: 86.4px; top: 357.481px; font-size: 13.6px; font-family: serif; transform: scaleX(1.01508);" data-canvas-width="378.3724000000001">syndromic surveillance, notifiable disease, and outbreak data during</div><div style="left: 86.4px; top: 373.481px; font-size: 13.6px; font-family: serif; transform: scaleX(1.00134);" data-canvas-width="91.40559999999999">a mass gathering</div><div style="left: 86.4px; top: 403.928px; font-size: 13.6px; font-family: sans-serif; transform: scaleX(1.11862);" data-canvas-width="79.3288">Introduction</div><div style="left: 100.8px; top: 418.281px; font-size: 13.6px; font-family: serif; transform: scaleX(1.05003);" data-canvas-width="364.4990399999996">The 2016 U.S. Olympic Track and Field Team Trials were held</div><div style="left: 86.4px; top: 434.281px; font-size: 13.6px; font-family: serif; transform: scaleX(1.03398);" data-canvas-width="378.47168">July 1-10 in Eugene, OR. This mass gathering included over 1,000</div><div style="left: 86.4px; top: 450.281px; font-size: 13.6px; font-family: serif; transform: scaleX(0.982111);" data-canvas-width="377.17967999999985">athletes, 1,500 volunteers, and 175,000 spectators. The Oregon Public</div><div style="left: 86.4px; top: 466.281px; font-size: 13.6px; font-family: serif; transform: scaleX(0.994828);" data-canvas-width="379.87519999999984">Health Division (PHD) and Lane County Public Health (LCPH)</div><div style="left: 86.4px; top: 482.281px; font-size: 13.6px; font-family: serif; transform: scaleX(0.995818);" data-canvas-width="380.18664">participated in pre-event planning and collaborated to produce a</div><div style="left: 86.4px; top: 498.281px; font-size: 13.6px; font-family: serif; transform: scaleX(1.00301);" data-canvas-width="377.78352">daily epidemiology report for the Incident Management Team (IMT)</div><div style="left: 86.4px; top: 514.281px; font-size: 13.6px; font-family: serif; transform: scaleX(0.957341);" data-canvas-width="378.93136">during the event. The state and county public health agencies had</div><div style="left: 86.4px; top: 530.281px; font-size: 13.6px; font-family: serif; transform: scaleX(1.01078);" data-canvas-width="378.2010399999999">collaborated on surveillance for prior mass gatherings, including the</div><div style="left: 86.4px; top: 546.281px; font-size: 13.6px; font-family: serif; transform: scaleX(0.99403);" data-canvas-width="377.39999999999975">2012 Trials. However, 2016 was the first opportunity to use complete</div><div style="left: 86.4px; top: 562.281px; font-size: 13.6px; font-family: serif; transform: scaleX(1.00126);" data-canvas-width="247.77840000000003">state and county syndromic surveillance data.</div><div style="left: 86.4px; top: 592.728px; font-size: 13.6px; font-family: sans-serif; transform: scaleX(1.07381);" data-canvas-width="55.9096">Methods</div><div style="left: 100.8px; top: 607.081px; font-size: 13.6px; font-family: serif; transform: scaleX(0.998382);" data-canvas-width="365.54079999999993">PHD staff developed an ESSENCE report, highlighting seven</div><div style="left: 86.4px; top: 623.081px; font-size: 13.6px; font-family: serif; transform: scaleX(1.02658);" data-canvas-width="378.68791999999956">priority health outcomes: total emergency department visits; injury,</div><div style="left: 86.4px; top: 639.081px; font-size: 13.6px; font-family: serif; transform: scaleX(1.03656);" data-canvas-width="374.45559999999995">gastrointestinal, respiratory, and fever syndromes; and asthma-</div><div style="left: 86.4px; top: 655.081px; font-size: 13.6px; font-family: serif; transform: scaleX(0.983981);" data-canvas-width="374.5031999999999">like and heat-related illness queries. The report included side-by-</div><div style="left: 86.4px; top: 671.081px; font-size: 13.6px; font-family: serif; transform: scaleX(0.986568);" data-canvas-width="380.02616000000006">side comparisons of county and state time series graphs, a table</div><div style="left: 86.4px; top: 687.081px; font-size: 13.6px; font-family: serif; transform: scaleX(1.03709);" data-canvas-width="379.02248000000003">summarizing reportable diseases, and space to narratively describe</div><div style="left: 86.4px; top: 703.081px; font-size: 13.6px; font-family: serif; transform: scaleX(1.01227);" data-canvas-width="380.4953599999996">outbreaks. PHD staff did a virtual demonstration and in-person</div><div style="left: 86.4px; top: 719.081px; font-size: 13.6px; font-family: serif; transform: scaleX(1.03429);" data-canvas-width="378.72328">tutorial for LCPH staff on how to run the report. ESSENCE access</div><div style="left: 86.4px; top: 735.081px; font-size: 13.6px; font-family: serif; transform: scaleX(1.04838);" data-canvas-width="378.9367999999998">permissions had to be modified so that county users could see and</div><div style="left: 86.4px; top: 751.081px; font-size: 13.6px; font-family: serif; transform: scaleX(0.964724);" data-canvas-width="379.2972">produce state time-series graphs but not data details for non-Lane</div><div style="left: 86.4px; top: 767.081px; font-size: 13.6px; font-family: serif; transform: scaleX(1.02508);" data-canvas-width="380.9713599999997">County visits. Emphasis was placed on interpretation of likely</div><div style="left: 86.4px; top: 783.081px; font-size: 13.6px; font-family: serif; transform: scaleX(0.989655);" data-canvas-width="377.45439999999985">scenarios, i.e., one or two days with a warning that was not indicative</div><div style="left: 86.4px; top: 799.081px; font-size: 13.6px; font-family: serif; transform: scaleX(1.00133);" data-canvas-width="231.54000000000005">of an incident of public health importance.</div><div style="left: 86.4px; top: 829.528px; font-size: 13.6px; font-family: sans-serif; transform: scaleX(1.0848);" data-canvas-width="49.123200000000004">Results</div><div style="left: 100.8px; top: 843.881px; font-size: 13.6px; font-family: serif; transform: scaleX(1.05485);" data-canvas-width="367.15648">During the event, LCPH staff were able to run the report</div><div style="left: 86.4px; top: 859.881px; font-size: 13.6px; font-family: serif; transform: scaleX(1.03689);" data-canvas-width="378.48392000000007">successfully, i.e., there were no technical glitches. For the first few</div><div style="left: 86.4px; top: 875.881px; font-size: 13.6px; font-family: serif; transform: scaleX(0.964553);" data-canvas-width="379.1176799999997">days, LCPH staff consulted with PHD staff about epidemiological</div><div style="left: 86.4px; top: 891.881px; font-size: 13.6px; font-family: serif; transform: scaleX(1.03633);" data-canvas-width="378.7790399999995">interpretation. State data were of specific interest since data details</div><div style="left: 86.4px; top: 907.881px; font-size: 13.6px; font-family: serif; transform: scaleX(0.995451);" data-canvas-width="379.96359999999993">were suppressed. Additionally, increases were seen in the injury</div><div style="left: 86.4px; top: 923.881px; font-size: 13.6px; font-family: serif; transform: scaleX(1.0237);" data-canvas-width="378.41184000000004">syndrome in the days preceding the July 4 holiday. Stratification by</div><div style="left: 86.4px; top: 939.881px; font-size: 13.6px; font-family: serif; transform: scaleX(0.970115);" data-canvas-width="379.1693600000002">key demographic factors and looking at subsyndrome breakdowns</div><div style="left: 86.4px; top: 955.881px; font-size: 13.6px; font-family: serif; transform: scaleX(1.02426);" data-canvas-width="378.6851999999999">on warning and alert days provided the needed information without</div><div style="left: 86.4px; top: 971.881px; font-size: 13.6px; font-family: serif; transform: scaleX(1.0014);" data-canvas-width="202.0824000000001">requiring the use of the detail details.</div><div style="left: 86.4px; top: 1002.33px; font-size: 13.6px; font-family: sans-serif; transform: scaleX(1.10338);" data-canvas-width="81.6136">Conclusions</div><div style="left: 100.8px; top: 1016.68px; font-size: 13.6px; font-family: serif; transform: scaleX(1.01926);" data-canvas-width="366.4248000000002">After the event, there were three main recommendations for</div><div style="left: 86.4px; top: 1032.68px; font-size: 13.6px; font-family: serif; transform: scaleX(1.00142);" data-canvas-width="124.2768">improving the process.</div><div style="left: 100.8px; top: 1048.68px; font-size: 13.6px; font-family: serif; transform: scaleX(1.00519);" data-canvas-width="365.62240000000025">LCPH suggested that the side-by-side visualization of county</div><div style="left: 86.4px; top: 1064.68px; font-size: 13.6px; font-family: serif; transform: scaleX(1.02254);" data-canvas-width="378.45808">and state time series graphs was useful to see trends but the relative</div><div style="left: 86.4px; top: 1080.68px; font-size: 13.6px; font-family: serif; transform: scaleX(1.02692);" data-canvas-width="378.55599999999964">scale of the number of visits was unclear due to size and placement</div><div style="left: 86.4px; top: 1096.68px; font-size: 13.6px; font-family: serif; transform: scaleX(1.05723);" data-canvas-width="381.69487999999996">(see figure 1). Solutions for future reports include additional</div><div style="left: 86.4px; top: 1112.68px; font-size: 13.6px; font-family: serif; transform: scaleX(0.962468);" data-canvas-width="377.1592799999999">explanatory text, limiting the report to only county data, and alternative</div><div style="left: 86.4px; top: 1128.68px; font-size: 13.6px; font-family: serif; transform: scaleX(1.00222);" data-canvas-width="339.98639999999983">visualizations that highlight the differences in visit magnitude.</div><div style="left: 100.8px; top: 1144.68px; font-size: 13.6px; font-family: serif; transform: scaleX(1.02139);" data-canvas-width="363.92240000000004">As part of the IMT process, the LCPH lead felt that her efforts to</div><div style="left: 86.4px; top: 1160.68px; font-size: 13.6px; font-family: serif; transform: scaleX(1.02579);" data-canvas-width="378.60360000000003">physically go to the Emergency Operations Center to run the report</div><div style="left: 489.6px; top: 325.481px; font-size: 13.6px; font-family: serif; transform: scaleX(0.980008);" data-canvas-width="379.49168">helped facilitate communication with partners. However, it is not</div><div style="left: 489.6px; top: 341.481px; font-size: 13.6px; font-family: serif; transform: scaleX(0.983269);" data-canvas-width="377.31295999999963">clear if this effort directly translated into IMT use of the report, which</div><div style="left: 489.6px; top: 357.481px; font-size: 13.6px; font-family: serif; transform: scaleX(1.00686);" data-canvas-width="378.04327999999987">was posted to the online event management system and not included</div><div style="left: 489.6px; top: 373.481px; font-size: 13.6px; font-family: serif; transform: scaleX(1.00003);" data-canvas-width="377.74408">in the daily situation status reports. While LCPH leadership and staff</div><div style="left: 489.6px; top: 389.481px; font-size: 13.6px; font-family: serif; transform: scaleX(0.969621);" data-canvas-width="379.4128">reported anecdotally that they found the report to be very useful,</div><div style="left: 489.6px; top: 405.481px; font-size: 13.6px; font-family: serif; transform: scaleX(0.951022);" data-canvas-width="378.9504000000002">no formal evaluation of use was done with either public health or</div><div style="left: 489.6px; top: 421.481px; font-size: 13.6px; font-family: serif; transform: scaleX(0.999587);" data-canvas-width="377.7440799999999">IMT staff. In advance of the next event, state and county staff should</div><div style="left: 489.6px; top: 437.481px; font-size: 13.6px; font-family: serif; transform: scaleX(1.00145);" data-canvas-width="151.0688">prepare evaluation metrics.</div><div style="left: 504px; top: 453.481px; font-size: 13.6px; font-family: serif; transform: scaleX(0.998914);" data-canvas-width="363.3715999999999">The report feature in ESSENCE is a bit cumbersome to set up, but</div><div style="left: 489.6px; top: 469.481px; font-size: 13.6px; font-family: serif; transform: scaleX(1.01625);" data-canvas-width="378.36695999999995">it allows for easy production of appealing and customizable reports.</div><div style="left: 489.6px; top: 485.481px; font-size: 13.6px; font-family: serif; transform: scaleX(1.01836);" data-canvas-width="378.3724000000001">This template can be modified for future mass gatherings, including</div><div style="left: 489.6px; top: 501.481px; font-size: 13.6px; font-family: serif; transform: scaleX(1.01648);" data-canvas-width="380.48584">athletic competitions and county fairs. PHD staff will continue</div><div style="left: 489.6px; top: 517.481px; font-size: 13.6px; font-family: serif; transform: scaleX(0.950386);" data-canvas-width="378.68112">to collaborate with LCPH to repurpose and improve the report for</div><div style="left: 489.6px; top: 533.481px; font-size: 13.6px; font-family: serif; transform: scaleX(0.962147);" data-canvas-width="379.3584000000001">use in Lane and other counties. Fostering local user comfort with</div><div style="left: 489.6px; top: 549.481px; font-size: 13.6px; font-family: serif; transform: scaleX(1.01873);" data-canvas-width="378.52472000000006">interpreting ESSENCE data and generating summaries for local use</div><div style="left: 489.6px; top: 565.481px; font-size: 13.6px; font-family: serif; transform: scaleX(1.00122);" data-canvas-width="215.3288000000001">is a priority of the OR ESSENCE team.</div>}, number={1}, journal={Online Journal of Public Health Informatics}, author={Jagger, Meredith A. and Jaramillo, Selene and Boyd, Laurel and Johnson, Brian and Reed, Kelly R. and Powell, Melissa}, year={2017}, month={May} }