| INTERJURISDICTIONAL DATA SHARING AND NATIONAL REPORTING
OF HUMAN CASES The public and animal health response to outbreaks of WN virus
involves all levels of government including the federal governments of the U.S.,
neighboring countries and the Pan American Health Organization. In addition, multiple
government agencies at each level are often involved. Rapid, efficient, secure and
coordinated systems to share human and ecologic data between these multiple agencies to
support long-term surveillance activities and to support activities that are part of the
rapid outbreak response are needed.
During an epidemic involving multiple jurisidictions, CDC and appropriate, authorized
users will use Epi-X, a CDC-based system for secured electronic communication or similar
integrated communication systems for rapid dissemination of information on public health
events of public health significance. User groups should be constructed in a logical and
efficient manner. For example, some public health officials need to receive veterinary and
wildlife data routinely, whereas others do not; the converse is also true.
Geographic information system (GIS) data should be used to track epidemics spatially.
A. Human Epidemiological, Clinical and Laboratory Data Collection
CDC will provide generic templates for electronic databases that can be rapidly
customized and stored centrally to allow efficient and secure interjurisdictional sharing
of human clinical and laboratory data during epidemics. Issues include:
1. Efficiency and Integrity
Centralized electronic databases should be designed to balance the need to maintain
data integrity with the desire to minimize duplicate data entry. On a regular and frequent
basis, such centralized databases should be backed up automatically with at least one
recent backup copy maintained off site.
2. Confidentiality and Security
Patient confidentiality statutes vary from state to state. Data can be shared between
jurisdictions if recipients agree to adhere to the confidentiality statutes of the state
providing the data. Electronic databases should be appropriately secured by passwords, to
limit access and minimize opportunities for breaches in confidentiality or security.
3. Standardization of Data Collection Instruments
Ideally, during an epidemic involving multiple jurisdictions, data collection (by both
electronic and written means) should be done in a standardized fashion across all
jurisdictions. While a more integrated and National Electronic Disease Surveillance System
(NEDSS)-compliant (http://www.cdc.gov/od.nissb/docs.htm) data collection instrument is
developed and disseminated, CDC will provide a list of the characteristics of data
variables (i.e., types, names, lengths, and order) that are contained in
centralized electronic databases.
4. Centralization
During an epidemic, centralized electronic databases for sharing epidemiological,
clinical and laboratory information should be maintained at CDC. These databases should be
accessible to authorized users via the Internet after all personal identifying information
has been removed.
B. National Reporting of Human Cases of WN Encephalitis
WN encephalitis is not on the list of nationally notifiable diseases maintained by the
Council of State and Territorial Epidemiologists (CSTE) in consultation with CDC. However,
this does not preclude states from reporting such cases to CDC, and CDC has designated
10056 as a specific disease code ("EVENT" code) for use in reporting WN
encephalitis cases via the National Electronic Telecommunications System for Surveillance
(NETSS). For national reporting purposes, states should use the national surveillance case
definition of arboviral encephalitis for classifying cases as either confirmed or
probable. WN meningoencephalitis should be added to the nationally notifiable diseases
list.
C. Ecologic Data
Many of the issues that apply to the interjurisdictional sharing of human data apply to
the sharing of ecologic data as well, although key differences exist. For example, in
terms of the latter, patient confidentiality is generally not an issue, except for owned
animals, while standardization of data collection is a far more challenging issue because
of the relatively large number of species often being studied. Specific needs include:
1. Accurate Taxonomic Identification of Specimens
Fully understanding the epidemiology and developing effective prevention and control
strategies for WN virus will require accurate identification of all animal species
involved in the virus transmission and maintenance cycles. This is especially true for
birds and mosquitoes.
2. Unique Identification (UI) Numbering System for Specimens
A standardized UI numbering system should be developed (or adopted from an existing
system) for wide-scale use by each state or independent jurisdiction. The numbering system
should readily distinguish between each major animal group (i.e., humans, birds,
and mosquitoes), county or township of collection, the year of collection, and a
specimen-specific number.
3. Durable Tagging System for Field-Collected Specimens
It is
critical that field specimens--whether blood, tissues, or whole animals--be properly
labeled so that specimen identification will not be lost during shipment to testing
facilities.
4. Standardized Data Collection and Specimen Submission Instruments
Standardized data collection forms should be developed and used for birds, mosquitoes,
and other animals. Some instruments already exist (e.g., at the USGS’s
National Wildlife Health Center and at CDC) and these could be a starting point for
development of additional instruments for general or specific usage. A difficulty may be
the wide taxonomic range (e.g., from mosquitoes to large mammals) and large number
of species often studied. |
Guidelines for Arbovirus Surveillance Programs in the United
States