Technical Updates

Patching Schedule

• April 18: NSSP vendor patches (Testing and Development) 12:00–8:00 AM ET (Completed)
• April 20: NSSP vendor patches (Onboarding and Production) 12:00–8:00 AM ET (Completed)
• May 16: NSSP vendor patches (Testing and Development) 12:00–8:00 AM ET
• May 18: NSSP vendor patches (Onboarding and Production) 12:00–8:00 AM ET

Onboarding Updates

On April 5, 2023, the NSSP onboarding team hosted the BioSense Platform Data Validation Call. This bimonthly call occurs on the first Wednesday of even-numbered months.

This month participants discussed the onboarding of non-emergency care facilities and incentives that would encourage participation in syndromic surveillance, including:

• Promoting Interoperability program points;
• include in ILINet, which would negate manual provider reporting; and
• create a presentation that explains the benefits of near-real–time data.

This is a worthwhile topic for discussion on Slack as well, so please watch for it and join in.

The next BioSense Platform Data Validation call will be held June 7, 2023, at 3:00 PM ET. Please join us to discuss onboarding and validation issues or ask questions. Many site administrators and others experienced in the onboarding process take part and may have the answer or experience you seek. To join, email your request to the NSSP mailbox: nssp@cdc.gov.

Mortality Data

During the March 22, 2023, NSSP Community of Practice (CoP) call, Dr. Edward Lockhart (NSSP) and Richard Raines (AK) provided an update about the mortality data source titled “NSSP Mortality Data: What’s going on?” Their goal was to share technical updates about the data source and take the initial steps of showing utility for incorporating mortality data into surveillance practice. Anna Frick (AK) contributed to the Q&A part of the discussion by describing the convenience of having mortality data (for example, she adds widgets to ESSENCE dashboards for mortality items of special concern, such as deaths due to flu).

Lockhart kicked off the presentation by thanking attendees for the level of engagement around mortality data that NSSP is experiencing. Eight states are using mortality data, many encouraging discussions are in progress, and NSSP is working with six states to finalize onboarding plans.

Addition of New Cause of Death Lists

Lockhart announced that mortality data now include select Cause of Death (CoD) lists. The CoD lists, created by the National Center for Health Statistics (NCHS) and vetted by the World Health Organization, were created to give insight into general mortality and are used to rank the leading causes of death.

NSSP recently added three of these lists to its production environment: CoD 113 list (General Mortality), CoD 130 List (Infant Mortality), and CoD 358 list (Comprehensive Mortality). (Note: The 113 list is derived from the more comprehensive 358 list but lacks the granularity). The lists have already served as catalysts for preliminary analyses at CDC for events of public health concern.

The Bigger Picture for Mortality Data

The business cases for how to use anonymous mortality data are still being assessed. For example, Frick described how tuberculosis (TB) has been a challenging public health problem in Alaska. She uses mortality data to identify instances where TB might have been a contributing factor, treating mortality data as one more metric that can be used to assess disease severity. Lockhart will update the community as more ways to use mortality data are brought to his attention.

Learn More

Onboarding of mortality data can be fast—Alaska was onboarded in just a week and a half! Commonly asked questions about mortality data are on the NSSP website. Mortality data are discussed in the April NSSP CoP call, posted on the Knowledge Repository. An NSSP article describes the routing of mortality data. There’s also a slack channel: #Mortality-data. To begin submitting mortality data, please contact nssp@cdc.gov.

State-developed Dashboards that Use Syndromic Data

Near-real–time data are used by CDC, partners, and state and local health departments. NSSP posts examples of how these data are used and integrated with other data sources on its Using Dashboards to Present NSSP Data website. These states were recently added to NSSP’s website:

• Kansas displays emergency department visits for Acute Respiratory Illness, Respiratory Syncytial Virus (RSV), COVID-19, and Influenza (Flu). The layout works well with mobile devices. The time series can be restricted to specific regions of the state. Kansas also provides an All-Drug Overdose ED Visit Spike and Cluster Alert Map for categories All Drugs, Any Opioid, Benzodiazepine, Heroin, and Stimulants. Data can be filtered by month and year. Changes in usage can be observed by county.
• Minnesota provides a comprehensive weekly COVID-19 Report that includes syndromic surveillance data. The Minnesota Department of Health integrates a variety of data sources (case and variants, vaccine data, hospitalization and capacity, vaccine breakthrough, mortality, and emergency department chief complaints) into customized reports and dashboards.
• With one click, the Nebraska Respiratory Illness Dashboard can show results for COVID-19, Respiratory Syncytial Virus (RSV), or Influenza. Each set of visuals shows tests performed, including positive tests and percent positive; emergency department visits; and emergency department visits by age group. This is a clean, easy-to-navigate dashboard.
• Nevada collects data from a variety of sources to monitor respiratory illnesses. Nevada’s dashboard includes influenza virus testing and subtyping results; NSSP data from emergency departments, inpatient, and outpatient visits for influenza and COVID-like illnesses; mortality data; RSV infections, and statewide estimates of influenza vaccination coverage. The easy-to-use graphical displays include trends, demographics, and yearly change.
• New York City monitors emergency department chief complaints related to respiratory conditions. Options abound on this dashboard. Respiratory counts (syndromes) are shown by neighborhood ZIP Code. Users may select a syndrome, timeframe, time resolution, metric, and visual.
• The Virginia Department of Health (VDH) generates a Weekly Influenza Activity Report that summarizes key points about influenza activity in a text format to accompany data visualizations. VDH collects and analyzes data on visits to emergency departments and urgent care centers for influenza-like illness (ILI), including stratifying ILI activity by age and region. The report also includes laboratory results of confirmatory influenza tests, suspected/confirmed influenza outbreaks, and pediatric/adult influenza deaths.

For all state-developed and other dashboards that use syndromic surveillance, access Using Dashboards to Present NSSP Data | CDC.

Publication Updates

• 

  A report released in CDC’s Morbidity and Mortality Weekly Report (MMWR) shows emergency department visits for firearm injuries increased during the COVID-19 pandemic compared with 2019. The report, Emergency Department Visits for Firearm Injuries Before and During the COVID-19 Pandemic—United States, January 2019–December 2022, uses NSSP’s near-real–time data to help show why public health practitioners need to take a comprehensive approach to preventing and responding to firearm injuries.

• A new job aid is available: How to Use NSSP–ESSENCE CCI and DDI Data Quality Filters. The job aid explains how to select filters to compensate for changes in data quality over time for the purpose of analyzing syndromic trends. This job aid was produced in collaboration with the Wisconsin Department of Health Services.
• Getting Started as a Site Administrator (Job Aid)—Describes week one activities, core contacts, and setup. Start with this job aid before advancing to the Ultimate Guide job aid.
• Rnssp v0.2.0 has been released.
• New Data Quality Template is now available to Rnssp users on Production data. This template calculates and summarizes syndromic surveillance data quality metrics pulled from the BioSense Platform and ESSENCE application programming interface (API). The template assesses coverage, timeliness, completeness, and validity of patient encounters (ED visits) limited to the selected calculated patient class (C_Patient_Class) that occurred during the chosen date range. Rnssp users can extend their installation of the package with this and other templates via Rnssp RStudio add-ins.
• The Data Quality (DQ) Dashboard User Manual, Version 2, is scheduled for release late spring 2023. This manual supports the revamped DQ Dashboard application. The dashboard’s user interface will use grid cards to display graphical and tabular information and assist site administrators in evaluating data flow, completeness, validity, and timeliness of submitted data.