CSTE Shelter Surveillance WorkgroupAlicia Lepp

Epidemiologist

North Dakota Department of Health

Workgroup History2014 Annual Disaster Epidemiology Workshop

First call on November 20, 2014

Meet on a monthly basis

Goal to create a shelter surveillance guidance document

Goals and ObjectivesDefining shelter surveillance and other terms

Identifying existing resources

Reaching out to partners

Creating guide for shelter surveillance

Identifying training resources and gaps

Making the case for shelter surveillance as an important part of disaster response

DefinitionsShelter : Communities must plan for the eventuality that some residents will lack the means or opportunity to find their own temporary accommodations in a disaster. To meet this need, communities open emergency shelters. Not only do emergency shelters provide immediate refuge from a threatened or actual incident, but may also provide food, water, and access to community services.

Shelter resident: Red Cross definition is head on the bed at midnight

Issues of public health concern: Population monitoring, environmental health and safety assessment, and accessibility for populations with special needs.

Outline of Guidance Document Introduction

Operations and Logistics Considerations

How to Gather Data

How to Get Data to Appropriate People

How to Analyze and Interpret the Data

How to Communicate Results

IntroductionPurpose

Audience

Definitions

Operations and Logistics ConsiderationsOperational, safety, and resource challenges

Emergency Service Functions

Mechanisms to request assistance

How to Gather DataReadiness

Conduct readiness activities on a routine basis before a disaster to build relationships with partners and establish collaborations

Partners to Engage

Recognize partners to engage with

Identify groups that can help fill human resource needs

Starting and Stopping Data

Conduct surveillance on shelters that are open for at least 3 days

Initiate surveillance within 24 hours of activation

How to Gather Data, cont. Process in the Shelter

Who implements surveillanceC-MIST model

CommunicationMaintaining HealthIndependenceSafety, Support, and Self DeterminationTransportation

Data CollectionWhen and how often to collect dataFactors that influence timing of data collection

Types of Data Collection

Aggregate Morbidity Report Form

Provides information on demographics

Tally section record CMIST groups

Natural Disaster Morbidity Surveillance Individual Form

Individual level data

Visits to first aid or medical unit

Large number of medical conditions

Natural Disaster Morbidity Surveillance Line ListAbbreviated version of individual form

Summary information

Natural Disaster Morbidity Surveillance Tally Sheet

Similar to American Red Cross

Summary level data

Natural Disaster Morbidity Surveillance Summary Report

Aggregate Data

Reporting Purposes

Situational Awareness

Environmental Health Shelter Assessment

Aggregate Data

Reporting Purposes

Situational Awareness

How to Gather Data, cont. Challenges and Solutions

Limited resources

Competing priorities

Damage to shelter or surrounding areas

How to Get Data to Appropriate PeopleReceiving the Data

Identify who should receive data and analyze

Keep list of individuals and contact information

Data Transfer

Send to one or more individuals vs. sending to dedicated email

Preferred method for data transfer

How to Get Data to Appropriate People, cont.Timing of Data Transfer

How frequent

Timing intervals

Needs of partners & stakeholders

Operational period of ICS

Challenges and Solutions

Logistics

Confidentiality and personal identifiers

How to Analyze and Interpret Data

Data Entry

Data Collection Format Data Entry

Paper Form Collection Enter data into an electronic dataset using software that

is familiar, easily accessible, and maintainable.

Build the data entry platform prior to conducting field

work.

Train data entry staff so they are familiar with the

software and use proper techniques to promote quality

and accuracy during entry.

Electronic Device Collection Merge collected data into a single file for analysis

How to Analyze and Interpret Data, cont.

Data AnalysisConsider technical capacity, complexity of analysis, frequency of analysis

Measure Definition

Incident cases† The occurrence of new cases of disease or injury in a population over a

specified period

Prevalent cases† The existing cases of disease, or injury in a population over a specified period

Incidence rate (new cases)‡ The number of new cases of a disease or injury that occur during a specified

period per unit of person-time at risk (can be stratified by age and sex)

Prevalence or prevalence rate

(total existing cases)†

The proportion of people in a population who have a particular health

condition at a specified point in time or over a specified period

Age-specific morbidity rate (<5

years, >5 years)‡

A morbidity rate limited to a particular age group (e.g., under-5 mortality rate

[U5MR] is the rate of death among children younger than 5 years in a

population)

Incidence proportion (attack

rate, generally used for

infectious conditions)†

The proportion of an initially disease-free population that develops disease,

becomes injured, or dies during a specified (usually limited) period

Proportional morbidity§ The proportion of all new or existing cases in a specified population over a

period attributable to a specific cause

Health facility utilization rate‡ The number of outpatient visits per person per year (if it is possible,

distinguish between new and old visits and use new visits to calculate the

rate)

Number of consultations per

clinician per day‡

The average number of total consultations (new and repeat cases) seen by

each clinician per day

How to Analyze and Interpret Data, cont.

Epi InfoUser-friendlyOn-line tutorialsFree

Interpreting Results for Action (when do we pull the trigger?)Changes in trends of illness in shelterTwo or more cases, from different family groups, with similar symptomsTwo or more cases, with similar symptoms, that are linked (i.e., similar activities, what and where they ate)Symptoms or syndromes indicating the potential for communicable disease outbreaks

How to Analyze and Interpret Data, cont.Respiratory

Cough, runny nose, water eyes

Fever (Temp >101.1⁰F) and cough in adults

Fever (Temp >101.1⁰F) and cough in children

Fever (Temp >101.1⁰F), cough with bloody sputum, and weight loss

Diarrhea or Vomiting

Vomiting

Loose or unformed stools

o Water or explosive stools, with or without blood

Skin

Fever (Temp >101.1⁰F) and rash

Fever (Temp >101.1⁰F), upper chest rash, and stiff/sore neck

Eye infections (drainage from eye)

Draining wound/lesion

Itchy rash without fever

How to Analyze and Interpret Data, cont.

Challenges and Solutions

Denominator data

Baseline health information

Competing priorities

How to Communicate ResultsAudience

Writing a ReportFormatHow much information to includeTechnical levelAvoid internal jargon/acronyms

Dissemination MethodsESF-8 Meetings, phone calls, web-site updatesPublic

Web Site postingsTV and radioSocial media

Challenges and SolutionsControlling media rumors

AppendixCMIST

American Red Cross Disaster Health Services Aggregate Morbidity Report Form

Natural Disaster Morbidity Surveillance Individual Form

Natural Disaster Morbidity Surveillance Line List

Natural Disaster Morbidity Surveillance Tally Sheet

Natural Disaster Morbidity Surveillance Summary Report

Environmental Health Shelter Assessment

AcknowledgementsCSTE Shelter Surveillance Workgroup

Amy SchnallAshley ConleyDoug ThoroughmanErica ThomassonJessica WursterJessica HelmsMary Casey LockyerMelissa MorrisonMiguel CruzNamitha ReddyNicole NakataTracy Miller