SURVEILLANCE SYSTEMS

Organized surveillance efforts provide the infrastructure for conveying information to facilitate a timely and appropriate response to a possible covert act of biological, chemical, or radiation terrorism.

Syndromic Surveillance System

The Syndromic Surveillance System involves the ongoing, systematic collection, analysis, interpretation, and application of real-time indicators for disease, allowing for detection before public health authorities would otherwise identify them.

Syndromic surveillance is an investigational approach in which health department staff, assisted by automated data acquisition and generation of statistical alerts, monitor disease indicators in real-time or near real-time to detect outbreaks of disease earlier than would otherwise be possible with conventional reporting of confirmed cases (Kulessa et al., 2021).

The National Syndromic Surveillance Program (NSSP) collects, analyzes, and shares electronic patient encounter data received from emergency departments, urgent and ambulatory care centers, inpatient healthcare settings, and laboratories. The electronic data are integrated through the shared BioSense Platform. Over 6 million electronic health messages are received by the BioSense Platform every day (CDC, 2021a).

In the case of a covert act of terrorism, healthcare providers—including emergency department staff and acute care clinic physicians, nurses, assistive personnel, and infection prevention specialists—play a key role in initiating the response to an act of bioterrorism. These individuals must have the knowledge to identify and initiate a local response to an act of bioterrorism. Their knowledge of what is usual among their patient population will provide the starting point for syndromic surveillance, relying as much on objective knowledge of community trends as on the instinct most professionals develop about what is “normal” for their setting. Clinical features that may be noted include:

• A cluster of persons from a common geographical area with similar symptoms
• A rapid increase in patients presenting with similar signs and symptoms
• An increase in patients who die within 72 hours after hospitalization
• An unusual clinical presentation
• An increased number of dead animals
• Signs and symptoms of biologic warfare agents
• Sudden increases in the use of over-the-counter drug purchases

All of these factors indicate a change in health from the status quo in a community. A clinician with a sense of the community’s general normal health can make a big difference in how soon a response to the threat begins. Clinicians should be aware that if a person admits to no foreign travel in endemic areas of rare viruses, then the suspicion level is high and the local health department or CDC should be contacted (Williams et al., 2021).

BioWatch Program

Established in 2003, the Department of Homeland Security BioWatch Program provides air-monitoring analysis for biological agents likely to be used in a bioterrorism attack, notification procedures, and risk assessment to more than 30 major metropolitan areas across the country.

Currently the DHS is working to upgrade bio-detection technology with the intention of:

• Better addressing a wide range of bioterrorism threats
• Providing real-time data across the Homeland Security organization
• Improving information-sharing between federal, state, and local operators

At the same time, the U.S. Department of Defense is evaluating devices to detect clouds of biological warfare agents in the air (U.S. DHS, 2020; DeSarkissian, 2021).

CDC Health Alert Network (HAN)

CDC’s Health Alert Network (HAN) is its primary method of sharing cleared information about urgent public health incidents with public information officers; federal, state, territorial, tribal, and local public health practitioners; clinicians; and public health laboratories. CDC’s HAN also collaborates with federal, state, territorial, tribal, and city/county partners to develop protocols and stakeholder relationships that will ensure a robust interoperable platform for the rapid distribution of public health information (CDC, 2020b).

Individuals can sign up on the CDC website to receive HAN email updates or subscribe to HAN RSS feeds. (See “Resources” at the end of this course.)

HAN MESSAGE TYPES

The HAN Messaging System directly and indirectly transmits information to over 1 million recipients. Message types are categorized by the level of urgency of the information.

• Health Alert: Provides vital, time-sensitive information for a specific incident or situation; warrants immediate action or attention by health officials, laboratorians, clinicians, and members of the public; conveys the highest level of importance
• Health Advisory: Provides important information for a specific incident or situation; contains recommendations or actionable items to be performed by public health officials, laboratorians, and/or clinicians; may not require immediate action
• Health Update: Provides updated information regarding an incident or situation; unlikely to require immediate action
• Info Service: Provides general public health information; unlikely to require immediate action
  (CDC, 2020b)

Nevada Health Alert Network (NVHAN)

The Nevada Division of Public and Behavioral Health (DPBH) Public Health Preparedness Program (PHP) administers the Nevada Health Alert Network (NVHAN) through a program called EMResource, a password-protected website. In addition to delivering NVHAN messages, EMResource is a resource management system used statewide and designed for healthcare providers, first responders, law enforcement, and critical infrastructure agencies such as energy, water, communications, etc. It provides comprehensive views of local, state, and regional resources, including bed tracking.

NVHAN relays important healthcare information received from the Centers for Disease Control and Prevention (CDC) and state and local agencies via Technical Bulletin (Juvare, 2021; NV DPBH, 2021).

State of Nevada employees, healthcare professionals, first responders/police/fire, or critical infrastructure agencies sign up to receive NVHAN alerts and information. (See “Resources” at the end of this course.)