title: Enhanced health event detection and influenza surveillance using a joint Veterans Affairs and Department of Defense biosurveillance application.
abstract: BACKGROUND
  The establishment of robust biosurveillance capabilities is an important component of the U.S. strategy for identifying disease outbreaks, environmental exposures and bioterrorism events. Currently, U.S. Departments of Defense (DoD) and Veterans Affairs (VA) perform biosurveillance independently. This article describes a joint VA/DoD biosurveillance project at North Chicago-VA Medical Center (NC-VAMC). The Naval Health Clinics-Great Lakes facility physically merged with NC-VAMC beginning in 2006 with the full merger completed in October 2010 at which time all DoD care and medical personnel had relocated to the expanded and remodeled NC-VAMC campus and the combined facility was renamed the Lovell Federal Health Care Center (FHCC). The goal of this study was to evaluate disease surveillance using a biosurveillance application which combined data from both populations.
  
  
  METHODS
  A retrospective analysis of NC-VAMC/Lovell FHCC and other Chicago-area VAMC data was performed using the ESSENCE biosurveillance system, including one infectious disease outbreak (Salmonella/Taste of Chicago-July 2007) and one weather event (Heat Wave-July 2006). Influenza-like-illness (ILI) data from these same facilities was compared with CDC/Illinois Sentinel Provider and Cook County ESSENCE data for 2007-2008.
  
  
  RESULTS
  Following consolidation of VA and DoD facilities in North Chicago, median number of visits more than doubled, median patient age dropped and proportion of females rose significantly in comparison with the pre-merger NC-VAMC facility. A high-level gastrointestinal alert was detected in July 2007, but only low-level alerts at other Chicago-area VAMCs. Heat-injury alerts were triggered for the merged facility in June 2006, but not at the other facilities. There was also limited evidence in these events that surveillance of the combined population provided utility above and beyond the VA-only and DoD-only components. Recorded ILI activity for NC-VAMC/Lovell FHCC was more pronounced in the DoD component, likely due to pediatric data in this population. NC-VAMC/Lovell FHCC had two weeks of ILI activity exceeding both the Illinois State and East North Central Regional baselines, whereas Hines VAMC had one and Jesse Brown VAMC had zero.
  
  
  CONCLUSIONS
  Biosurveillance in a joint VA/DoD facility showed potential utility as a tool to improve surveillance and situational awareness in an area with Veteran, active duty and beneficiary populations. Based in part on the results of this pilot demonstration, both agencies have agreed to support the creation of a combined VA/DoD ESSENCE biosurveillance system which is now under development.
authors.affiliation: Department of Veterans Affairs, Office of Public Health, Office of Public Health Surveillance and Research, Palo Alto, CA 94304, USA. cynthia.lucero@va.gov
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Lucero
authors.forename: Gina
authors.initials: G
authors.lastname: Oda
authors.forename: Kenneth
authors.initials: K
authors.lastname: Cox
authors.forename: Frank
authors.initials: F
authors.lastname: Maldonado
authors.forename: Joseph
authors.initials: J
authors.lastname: Lombardo
authors.forename: Richard
authors.initials: R
authors.lastname: Wojcik
authors.forename: Mark
authors.initials: M
authors.lastname: Holodniy
mesh_terms: D055877:Biosurveillance / Q000379:methods*; D016208:Databases, Factual; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D007251:Influenza, Human / Q000453:epidemiology*; D008297:Male; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D059030:United States Department of Defense; D014493:United States Department of Veterans Affairs