Influenza surveillance using electronic health records in the American Indian and Alaska Native population.

OBJECTIVE: Increasing use of electronic health records (EHRs) provides new opportunities for public health surveillance. During the 2009 influenza A (H1N1) virus pandemic, we developed a new EHR-based influenza-like illness (ILI) surveillance system designed to be resource sparing, rapidly scalable, and flexible. 4 weeks after the first pandemic case, ILI data from Indian Health Service (IHS) facilities were being analyzed. MATERIALS AND METHODS: The system defines ILI as a patient visit containing either an influenza-specific International Classification of Disease, V.9 (ICD-9) code or one or more of 24 ILI-related ICD-9 codes plus a documented temperature ≥100°F. EHR-based data are uploaded nightly. To validate results, ILI visits identified by the new system were compared to ILI visits found by medical record review, and the new system's results were compared with those of the traditional US ILI Surveillance Network. RESULTS: The system monitored ILI activity at an average of 60% of the 269 IHS electronic health databases. EHR-based surveillance detected ILI visits with a sensitivity of 96.4% and a specificity of 97.8% based on chart review (N=2375) of visits at two facilities in September 2009. At the peak of the pandemic (week 41, October 17, 2009), the median time from an ILI visit to data transmission was 6 days, with a mode of 1 day. DISCUSSION: EHR-based ILI surveillance was accurate, timely, occurred at the majority of IHS facilities nationwide, and provided useful information for decision makers. EHRs thus offer the opportunity to transform public health surveillance.

Prevalence of Borrelia burgdorferi in small mammals in New York state.

Intensive small mammal trapping was conducted in 12 counties in New York state during 1998-2000 to investigate the prevalence and site specificity of the Lyme disease spirochete, Borrelia burgdorferi in, and presence of the blacklegged tick, Ixodes scapularis Say on, the wild mice Peromyscus leucopus Rafinesque and Peromyscus maniculatus Wagner and other small mammal species. Previously captured mice (1992-1997) from throughout New York state also were recruited into the study, providing a total of 3,664 Peromyscus from 107 sites in 31 counties. Infection with B. burgdorferi was determined by polymerase chain reaction testing of ear tissue, and rates were determined by species, counties, and regions of the state. B. burgdorferi was detected in 10 small mammal species captured during 1998-2000. Peromyscus captured from Dutchess County in the lower Hudson Valley had the highest infection rate of 21%. The next highest infection rates were in counties within the Capital District: Albany (18%), Rensselaer (17%), and Columbia (13%). From 4,792 small animals examined, we recovered 2,073 ticks representing six species from 414 individuals of 12 mammal species, including 1,839 I. scapularis collected from 315 Peromyscus trapped in five counties. I. scapularis were most often collected from animals trapped in Albany, Rensselear, and Dutchess counties. We used protein electrophoresis of salivary amylase to distinguish between P. leucopus and P. maniculatus species. I. scapularis burdens were 5.7 ticks per P. leucopus and 14.3 ticks per P. maniculatus.

Small-area variations in conviction rates for DWI: the significance of contextual variables in a Southwestern state.

Average annual conviction rates (1990-2000) of people arrested for driving under the influence of alcohol in each of New Mexico's 33 counties are described. Conviction rates vary from 58 to 95%. Rates are correlated with political conservatism, being higher where a higher proportion of voters voted for the republican presidential candidates, and with measures of crowding in the courts. Conviction rates are higher in rural than urban areas and are correlated with a low prevalence of alcohol-related problems in the population. The variance in conviction rates is higher in rural than urban areas, and higher where measures of court crowding are low. The results suggest that political culture and the efficiency of court functioning are each independently associated with conviction rates for DWI and may also be associated in a reciprocal fashion with both low DWI arrest rates and alcohol-involved crash rates.