Brucella suis infection was diagnosed in a man from Tonga, Polynesia, who had butchered swine in Oregon, USA. Although the US commercial swine herd is designated brucellosis-free, exposure history suggested infection from commercial pigs. We used whole-genome sequencing to determine that the man was infected in Tonga, averting a field investigation.
ObjectiveTo streamline production of a daily epidemiology report includingsyndromic surveillance, notifiable disease, and outbreak data duringa mass gatheringIntroductionThe 2016 U.S. Olympic Track and Field Team Trials were heldJuly 1-10 in Eugene, OR. This mass gathering included over 1,000athletes, 1,500 volunteers, and 175,000 spectators. The Oregon PublicHealth Division (PHD) and Lane County Public Health (LCPH)participated in pre-event planning and collaborated to produce adaily epidemiology report for the Incident Management Team (IMT)during the event. The state and county public health agencies hadcollaborated on surveillance for prior mass gatherings, including the2012 Trials. However, 2016 was the first opportunity to use completestate and county syndromic surveillance data.MethodsPHD staff developed an ESSENCE report, highlighting sevenpriority health outcomes: total emergency department visits; injury,gastrointestinal, respiratory, and fever syndromes; and asthma-like and heat-related illness queries. The report included side-by-side comparisons of county and state time series graphs, a tablesummarizing reportable diseases, and space to narratively describeoutbreaks. PHD staff did a virtual demonstration and in-persontutorial for LCPH staff on how to run the report. ESSENCE accesspermissions had to be modified so that county users could see andproduce state time-series graphs but not data details for non-LaneCounty visits. Emphasis was placed on interpretation of likelyscenarios, i.e., one or two days with a warning that was not indicativeof an incident of public health importance.ResultsDuring the event, LCPH staff were able to run the reportsuccessfully, i.e., there were no technical glitches. For the first fewdays, LCPH staff consulted with PHD staff about epidemiologicalinterpretation. State data were of specific interest since data detailswere suppressed. Additionally, increases were seen in the injurysyndrome in the days preceding the July 4 holiday. Stratification bykey demographic factors and looking at subsyndrome breakdownson warning and alert days provided the needed information withoutrequiring the use of the detail details.ConclusionsAfter the event, there were three main recommendations forimproving the process.LCPH suggested that the side-by-side visualization of countyand state time series graphs was useful to see trends but the relativescale of the number of visits was unclear due to size and placement(see figure 1). Solutions for future reports include additionalexplanatory text, limiting the report to only county data, and alternativevisualizations that highlight the differences in visit magnitude.As part of the IMT process, the LCPH lead felt that her efforts tophysically go to the Emergency Operations Center to run the reporthelped facilitate communication with partners. However, it is notclear if this effort directly translated into IMT use of the report, whichwas posted to the online event management system and not includedin the daily situation status reports. While LCPH leadership and staffreported anecdotally that they found the report to be very useful,no formal evaluation of use was done with either public health orIMT staff. In advance of the next event, state and county staff shouldprepare evaluation metrics.The report feature in ESSENCE is a bit cumbersome to set up, butit allows for easy production of appealing and customizable reports.This template can be modified for future mass gatherings, includingathletic competitions and county fairs. PHD staff will continueto collaborate with LCPH to repurpose and improve the report foruse in Lane and other counties. Fostering local user comfort withinterpreting ESSENCE data and generating summaries for local useis a priority of the OR ESSENCE team.
ObjectiveTo build capacity to conduct syndromic surveillance at the locallevel by leveraging a health surveillance need.IntroductionWildfires occur annually in Oregon, and the health risks of wildfiresmoke are well documented1. Before implementing syndromicsurveillance through Oregon ESSENCE, assessing the health effectsof wildfires in real time was very challenging. Summer 2015 markedthe first wildfire season with 60 of 60 eligible Oregon emergencydepartments (EDs) reporting to ESSENCE. The Oregon ESSENCEteam developed a wildfire surveillance pilot project with two localpublic health authorities (LPHAs) to determine their surveillanceneeds and practices and developed a training program to increasecapacity to conduct surveillance at the local level. Following thetraining, one of the LPHAs integrated syndromic surveillance intoits routine surveillance practices. Oregon ESSENCE also integratedthe evaluation findings into the summer 2016 statewide wildfiresurveillance plan.MethodsOregon ESSENCE staff recruited two LPHA preparednesscoordinators whose jurisdictions are regularly affected by wildfiresmoke to participate in the pilot project. A state public healthemergency preparedness liaison served as facilitator in order toincrease syndromic surveillance capacity among state preparednessstaff.A pre-season interview assessed data and surveillance needs,risk communication practices, and typical response activities duringwildfires. Initial project calls focused on determining specific queriesthat would meet local needs. Participants wanted total ED visitnumbers and health outcomes including asthma, chest pain or heartproblems. Both LPHAs were interested in using the data to assesshealth effects on vulnerable populations, including elderly, children,and migrant workers. Oregon ESSENCE staff also recommendedqueries that would be used if large numbers of people were displaced(e.g., medication refills, dialysis).Before the onset of wildfire season, Oregon ESSENCEepidemiologists created queries and a MyESSENCE page for eachparticipant. LPHA staff practiced running the queries, modifyingthem, and discussed interpretation and data-sharing best practices.During wildfire season, brief weekly webinars enabled participantsto ask questions and learn additional techniques including displayingtime series as proportions and adjusting geographic parameters tofocus on areas with poor air quality.Results2015 was a severe wildfire season in Oregon, with over 685,000acres burned2. For the first time, local and state public health were ableto monitor and share near real-time health information on interagencysmoke calls. In the post project evaluation, participants reportedincreased knowledge of syndromic surveillance, interpretation,and risk communications. There were no marked increases in totalemergency department visits, or visits for asthma, heart palpitations,or other heart complaints. The public may have adhered to warningsand effectively protected themselves against exposure to wildfiresmoke, or health effects may have been less severe and not reflectedin emergency department data. Over the next several years, OregonESSENCE will integrate select urgent care data, which may bettercapture morbidity due to wildfire smoke.ConclusionsFraming syndromic surveillance training around a healthsurveillance need was effective because participants were engagedaround a high-priority health hazard. In summer 2016, OregonESSENCE integrated wildfire health surveillance into a biweeklyESSENCE seasonal hazard surveillance report and invited wildfireresponse partners to subscribe. Local ESSENCE users can use ormodify the queries. In 2017, Oregon ESSENCE will incorporate airquality data from the Environmental Protection Agency so partnerscan monitor air quality and health effects simultaneously.
The need to remove nutrients from wastewater by biological means and dispose of sludge by-products in an efficient manner has prompted the Greater Johannesburg Metropolitan Council to adopt a new approach to the management of industrial discharges. Giving a rebate on the normal discharge tariff will encourage the discharge of industrial effluents having a high readily biodegradable concentration (which would assist the BNR process). Those effluents having high concentrations of heavy metals (which would degrade the reuse value of sludge by-products) would be discouraged by means of an additional penalty above the normal discharge tariff.
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