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Published: Sunday, 8/22/2004

Health system to give early warning

BY LUKE SHOCKMAN
BLADE STAFF WRITER

A week before Spring Break, the alarms began going off.

Something odd was showing up in information flowing into a computer database that monitors over-the-counter drug sales in Ohio. The database was established as an early-warning system to detect runs on medication purchases that might signal major disease outbreaks, including a bioterrorist attack.

Ohio Health Department officials noticed a spike in the sale of electrolyte products - products such as Pedialyte sold to rehydrate infants after a vomiting spell. Could this rise in sales signal a disease outbreak? A sinister bioterrorist plot?

Not this time.

"We discovered that these spikes were occurring in some of the larger university towns," said Loren Shaffer, early event surveillance coordinator for the state health department. "Apparently these electrolyte products are used to rehydrate oneself after a drinking binge."

He said a lot of college kids were preparing for adventures over Spring Break, which - and don't tell mom or dad - presumably involved large amounts of alcohol. Though Mr. Shaffer said his staff laughed about the discovery, it was proof that the detection network is sensitive to drug sales.

Over-the-counter drug sales only tell so much, however. That's why Mr. Shaffer and other state health officials are pushing Ohio hospitals to join the Real-time Outbreak and Disease Surveillance (RODS) system. Developed by University of Pittsburgh researchers, RODS monitors emergency department admissions for trends similar to the way drug sales are being monitored.

Ohio wants more than a third of the state's 170-plus hospitals to be connected to the system by the end of the year. Blanchard Valley Regional Health Center in Findlay has already agreed to participate, and other northwest Ohio hospitals have said they probably will, too.

The intent is to quickly detect symptoms of a disease outbreak before the actual disease is diagnosed. Speed is essential in heading off a disease outbreak, whether it's naturally occurring or a bioterrorist event, said Mike Fielding, director of the office of emergency preparedness for the Columbus Health Department, which has been using RODS since December.

"If you can get any type of lead time on a response, that can be a matter of life or death," Mr. Fielding said. "RODS hasn't really proven itself yet, but it's definitely a step in the right direction.

Bob Campbell, chief of the state's bureau of health surveillance, said health officials have long relied on paper-based systems, where hospitals or doctors' offices send in periodic reports about diseases. But these methods are often slow, time-consuming, and may miss patterns, he said.

"The advantage of RODS systems is they look at the population. We might see patterns across a number of different facilities that no one facility would pick up on," Mr. Campbell said.

RODS uses computer software that taps into a hospital emergency room's computer network. Every time a patient is seen at an emergency department, a chief medical complaint is usually listed. RODS sends a copy of each of those chief complaints to a central database. Privacy is maintained, and no names are sent. Besides, the chief complaint, the system does collect information such as the patient's age, gender, and home ZIP code, as well as the date and time of the E.R. visit.

There's no cost for hospitals using the RODS system. Officials at St. Vincent Mercy Medical Center and Toledo Hospital, the region's two largest trauma hospitals, praised the program in interviews with The Blade. They said they'd likely participate, but first they want to know how RODS would tie in with their computer network.

Some might wonder if the reports of more than 300 people getting sick after visiting Put-in-Bay on South Bass Island in recent weeks were detected by the state's disease outbreak system as they were occurring.

The answer is no, said Bret Atkins, an Ohio Department of Health official.

Mr. Atkins said it is possible not enough people purchased over-the-counter medications in response to their illness. Perhaps a more likely reason authorities were not alerted is the fact that the pharmacy monitoring system is largely ZIP code based.

Because many of those who got sick were visitors or tourists, they were so widely dispersed in their places of residence that if they did purchase medications it wasn't enough to trigger alarms, he said. State health officials will likely examine data from the Ottawa County area after enough time has passed to see if they can learn from the outbreak and refine their monitoring system.

Eric Zgodzinski, a supervisor at the Toledo-Lucas County health department, said systems such as RODS are intended as "another tool in our toolbox to use."

His department is already using a similar tool. Last year, the department established a Web-based reporting system that tracks volume numbers for hospital emergency departments in Lucas County. It's a cruder version of RODS because volume alone may not be as useful as the more detailed information RODS tabulates.

Nonetheless, Mr. Zgodzinski said the Lucas County system is effective in picking up some patterns. For example, last year during ozone action days, the system picked up spikes at area emergency rooms, and further investigation found an increase in respiratory complaints those days.

Mr. Zgodzinski said to be even more effective, systems such as RODS would tie in other information, such as school absence data and physician office reports, something Lucas County does try to track. State officials agreed, saying they may eventually examine other areas, too, to better evaluate disease patterns.

RODS has two main components: The monitoring of emergency departments and the surveillance of over-the-counter drug sales.

The monitoring of over-the-counter drug sales in Ohio is already in place and covers 70 percent of the state. Ohio is one of 43 states doing this. This component of RODS has the same basic concept as the emergency department portion - sales of some drugs may signal an early outbreak of a disease as people self-medicate. The system is not foolproof, and there can be false alarms, as with the Spring Break example.

The emergency department portion is the newer component and is slowly expanding as hospitals come on-board. Ohio is one of only a few areas of the country to start such a broad-based emergency department surveillance system, Mr. Campbell said.

Pennsylvania was an early pioneer in using RODS, and it hopes to have most of its hospitals signed on by the end of the year.

"At the local hospital level, you might not see anything, but if you look at a county and see 30 people coming in complaining of the same thing, we might figure out they all had the same exposure. Maybe it was Aunt Millie's coleslaw," said Joel Hersh, director of the bureau of epidemiology for the Pennsylvania Department of Health. "So, it's a way to stop what's occurring."

Federal authorities are interested in setting up a nationwide system similar to RODS, and have already launched a program known as BioSense. That system monitors the lab tests performed by one of the country's largest clinical laboratories to see if any suspicious patterns emerge. BioSense recently tied into RODS data so it could track over-the-counter drug sales, too.

Eventually, the U.S. Centers for Disease Control and Prevention hope to expand BioSense so that it incorporates emergency-room admission data like RODS does, as well as other information. The idea is that all of this data would be automatically and continuously searched. In theory, a disease outbreak anywhere in the country could quickly be identified so that authorities could react.

Jim Seligman, a CDC spokesman, said it make take several years to establish such a system, though President Bush has proposed spending $100 million next year to speed the development of BioSense.

Contact Luke Shockman at:

lshockman@theblade.com

or 419-724-6084.



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