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Research Highlights
Extending Public Health Surveillance to Water Quality
Many cities and counties use electronic public health syndromic surveillance system programs to help identify potential disease outbreaks early.
Electronic PHSS systems currently evaluate a variety of health-related data, such as over-the-counter drug sales and emergency room information. Computers analyze these data for anomalies—for example, a sudden increase in the purchase of a certain type of medicine compared with purchases in the previous week, or month, or the same time in previous years. Epidemiologists analyze the systems’ outputs to determine whether a response by public health officials is warranted. Expanding PHSS Systems for Early Detection of Drinking Water ContaminationA pilot project is exploring whether information about our drinking water can be added to existing electronic PHSS systems. The pilot involves two nationwide PHSS systems, Real-Time Outbreak Disease Surveillance (RODS), and Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE). The additional data could be valuable if they enable officials to discover contamination earlier, and thus take preventive measures sooner.Participating water utilities are partnering with EPA to make information about their water quality and distribution system available to the RODS or ESSENCE system used by the public health departments within their service areas. The participating water utilities and public health departments will work with EPA, using RODS and ESSENCE to: (1) determine how to correlate the water quality information with their area’s existing public health data and (2) how to interpret the results. Water parameters that will be added to RODS and ESSENCE include turbidity, disinfectant levels, and pH. EPA researchers hope to have RODS and ESSENCE water modules available for distribution beyond the pilot cities in the next year. These modules will help officials determine more quickly whether a change in public health data is the result of contaminated drinking water. The water utilities and public health agencies can then cooperate to minimize the number of people affected and the severity of the water contamination. The modified RODS system will be developed with data from (and be tested in) Pittsburgh and Cincinnati. The modified ESSENCE system will be developed with data from (and be tested in) suburban Washington, D.C., and Milwaukee, Wisconsin. The information generated will also be used in other NHSRC programs, such as WaterSentinel (a distribution system monitoring program) and EPA message mapping workshops (communicating with the public when there is a significant risk). Expected ProductsThe PHSS system pilot project will yield protocols for the transfer of near-real-time water quality data into RODS and ESSENCE. Algorithms for determining justified alert levels will also be proposed for use in each system. A user’s guide for water utilities will be published in late 2006, and training on the enhanced surveillance systems will be provided to the pilot project participants. EPA hopes that RODS and ESSENCE water modules will become available for use by other jurisdictions in early 2007.
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