Council of State and Territorial Epidemiologists


VIII. Period of Surveillance



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VIII. Period of Surveillance

Indicate whether surveillance is expected to be on-going or limited to a specific time period.

On-going.
IX. Data sharing/release and print criteria

As appropriate, describe:



  • Expectations for sharing of case data (dataflow/notification from state/territorial health agency to CDC) and limitations on data sharing (e.g., states and territories will send CDC data for selected cases based on case classification; states and territories will send core/generic data or supplemental/extended data)

  • Limitations on data re-release by CDC (e.g., only fully de-identified case data will be released by CDC to the general public, other releases by CDC require signed data sharing agreements using a format pre-approved by the state/territorial health agency) [refer to CDC-CSTE Intergovernmental Data Release Guidelines Working Group (DRGWG) Report: CDC-ATSDR Data Release Guidelines and Procedures for Re-release of State-Provided Data (available at http://www.cste2.org/webpdfs/drgwgreport.pdf ) as necessary]

  • Restrictions on the printing of counts of case data (e.g., CDC publication criteria will exclude selected cases from final printed counts based on case classification; provisional case report data will not be used by CDC until verification procedures are complete).

Notification of cases to CDC is recommended via the American Association of Poison Control Center’s (AAPCC) National Poison Data System (NPDS).
There are no plans for the re-release of case data as the data are owned by AAPCC. Requests for case data should be to AAPCC.
CDC plans to conduct standard periodic analysis of NPDS data and may conduct ad-hoc analyses as a part of disaster response activities. Aggregate case data will be incorporated into presentations, the CDC website, or publications such as MMWR. CDC may share results of ad-hoc analyses conducted after disasters if requested by the impacted states.


X. References

Where appropriate, include references to prior CSTE position statements.

1. Centers for Disease Control and Prevention (CDC). Nonfatal, unintentional, non--fire-related carbon monoxide exposures--United States, 2004-2006. MMWR Morb Mortal Wkly Rep. 2008 Aug 22;57(33):896-9. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5733a2.htm

2. Centers for Disease Control and Prevention (CDC). Carbon monoxide--related deaths--United States, 1999-2004. MMWR Morb Mortal Wkly Rep. 2007 Dec 21;56(50):1309-12. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5650a1.htm

3. Centers for Disease Control and Prevention (CDC). Carbon monoxide exposures--United States, 2000-2009. MMWR Morb Mortal Wkly Rep. 2011 Aug 5;60(30):1014-7. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6030a2.htm

4. Centers for Disease Control and Prevention (CDC). Monitoring poison control center data to detect health hazards during hurricane season--Florida, 2003-2005. MMWR Morb Mortal Wkly Rep. 2006 Apr 21;55(15):426-8. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5515a2.htm

5. Lutterloh EC, Iqbal S, Clower JH, Spiller HA, Riggs MA, Sugg TJ, Humbaugh KE, Cadwell BL, Thoroughman DA. Carbon monoxide poisoning after an ice storm in Kentucky, 2009. Public Health Rep. 2011 May-Jun;126 Suppl 1:108-15. http://www.publichealthreports.org/issueopen.cfm?articleID=2651

6. Centers for Disease Control and Prevention (CDC). Carbon monoxide exposures after hurricane Ike - Texas, September 2008. MMWR Morb Mortal Wkly Rep. 2009 Aug 14;58(31):845-9. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5831a1.htm

7. Centers for Disease Control and Prevention (CDC). Notes from the field: carbon monoxide exposures reported to poison centers and related to hurricane Sandy - Northeastern United States, 2012. MMWR Morb Mortal Wkly Rep. 2012 Nov 9;61(44):905. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6144a5.htm?s_cid=mm6144a5_w

8. Graber JM, Smith AE. Results from a state-based surveillance system for carbon monoxide poisoning. Public Health Rep. 2007 Mar-Apr;122(2):145-54. http://www.publichealthreports.org/issueopen.cfm?articleID=1811

9. Spiller HA, Griffith JR. The value and evolving role of the U.S. Poison Control Center System. Public Health Rep. 2009 May-Jun;124(3):359-63. http://www.publichealthreports.org/issueopen.cfm?articleID=2197

10. Bekkedal M, Sipsma K, Stremski ES, Malecki KC, Anderson HA. Evaluation of five data sources for inclusion in a statewide tracking system for accidental carbon monoxide poisonings. WMJ. 2006 Mar;105(2):36-40. https://www.wisconsinmedicalsociety.org/_WMS/publications/wmj/pdf/105/2/36.pdf

11. Schier JG. Poison Control Centers and Toxicosurveillance: Real-time National Surveillance for Outbreaks of Chemical-Associated Illness. Presented May 2008 to CDC Emergency Preparedness & Response COCA conference call. http://www.bt.cdc.gov/coca/ppt/PoisonControl%20CentersToxicosurveillance_052008_FINAL.ppt

12. Wolkin AF, Martin CA, Law RK, Schier JG, Bronstein AC. Using poison center data for national public health surveillance for chemical and poison exposure and associated illness. Ann Emerg Med. 2012 Jan;59(1):56-61.

13. Hampson NB, Piantadosi CA, Thom SR, Weaver LK. Practice recommendations in the diagnosis, management, and prevention of carbon monoxide poisoning. Am J Respir Crit Care Med. 2012 Dec 1;186(11):1095-101.

14. Ball LB, Macdonald SC, Mott JA, Etzel RA. Carbon monoxide-related injury estimation using ICD-coded data: methodologic implications for public health surveillance. Arch Environ Occup Health. 2005 May-Jun;60(3):119-27.



XI. Coordination
Agencies for Response (List only one name per agency, preferably an individual in a senior management position; complete contact information must be provided for acceptance to review.)
(1) CDC

Agency


     

Contact Full Name

     

Title
     

Address Line 1
     

Address Line 2


     

City, State and Zip


     

Telephone Number


     

Email Address


(2)      

Agency


     

Contact Full Name

     

Title
     

Address Line 1
     

Address Line 2


     

City, State and Zip


     

Telephone Number


     

Email Address

(3)      

Agency


     

Contact Full Name

     

Title
     

Address Line 1
     

Address Line 2


     

City, State and Zip


     

Telephone Number


     

Email Address


*For additional Agencies for Response, please provide a separate attachment with complete contact information.

Agencies for Information: (Complete contact information must be provided for acceptance to review.)
(1) AAPCC

Agency


     

Contact Full Name

     

Title
     

Address Line 1
     

Address Line 2


     

City, State and Zip


     

Telephone Number


     

Email Address

(2)      

Agency


     

Contact Full Name

     

Title
     

Address Line 1
     

Address Line 2


     

City, State and Zip


     

Telephone Number


     

Email Address


(3)      

Agency

     


Contact Full Name

     


Title
     

Address Line 1


     

Address Line 2


     

City, State and Zip


     

Telephone Number


     

Email Address


*For additional Agencies for Information, please provide a separate attachment with complete contact information.

XII. Submitting Author: (Must be an Active CSTE Member and complete contact information provided for acceptance to review.)
(1) Steven C. Macdonald

Contact Full Name

     

Title
     



Agency
     

Address Line 1


     

Address Line 2


     

City, State and Zip


     

Telephone Number


     

Email Address



Co-Author: (Complete contact information must be provided for acceptance to review.)
(1)

     


Contact Full Name

     


Title
     

Agency
     

Address Line 1
     

Address Line 2


     

City, State and Zip


     

Telephone Number


     

Email Address


(2)

     


Contact Full Name

     


Title
     

Agency
     

Address Line 1
     

Address Line 2


     

City, State and Zip


     

Telephone Number


     

Email Address


*For additional Authors, please provide a separate attachment with complete contact information.
Table VI-B. Table of criteria to determine whether a case should be reported to public health authorities.

Criterion

Reporting

Disease or Condition Subtype



Reporting

Disease or Condition Subtype



Reporting

Disease or Condition Subtype



Clinical Evidence














































Laboratory Evidence














































Epidemiological Evidence














































Notes:

Each alternative disease or condition subtype is listed in a separate column. Each criterion (symptom, sign, lab result, immunization status, occupation, travel history, etc.) is listed in a separate row. Meeting the criteria listed under any single column of this table is sufficient to identify a case for reporting. [Change the generic “Disease or condition subtype” language to the appropriate term, which can be a clinical distinction (e.g., cutaneous anthrax, inhalational anthrax), or an agent (e.g., a type of arbovirus), or a route of exposure (e.g., foodborne botulism, wound botulism). Delete unnecessary columns. Use letter codes provided. Where the action of ordering a laboratory test meets a criterion for reporting, indicate by use of asterisk.]

S = This criterion alone is Sufficient to report a case.

N = All “N” criteria in the same column are Necessary to report a case.

O = At least one of these “O” (Optional) criteria in each category (e.g., clinical evidence and laboratory evidence) in the same column—in conjunction with all “N” criteria in the same column—is required to report a case. (These optional criteria are alternatives, which means that a single column will have either no O criteria or multiple O criteria; no column should have only one O.)

* A requisition or order for any of the “S” laboratory tests is sufficient to meet the reporting criteria.



Table VII-B. Criteria for defining a case of [condition].

NOTE: Please remember to incorporate the criteria specified in Section VII above titled “Criteria to distinguish a new case of this disease or condition from reports or notifications which should not be enumerated as a new case for surveillance,” which should be considered in determining whether to count this as a new case. This section is not applicable if not relevant to the condition. 





Criterion

Suspected

Probable

Confirmed

Clinical Evidence














































Laboratory evidence














































Epidemiologic evidence














































Criteria to distinguish a new case:










[Example: Not counted as a new case if occurred within 30 days of initial case]

N

N

N

Notes:

Each criterion (symptom, sign, lab result, immunization status, occupation, travel history, etc.) is listed in a separate row. Meeting the criteria listed under any single column of this table is sufficient to classify a case. [Use letter codes provided.]

S = This criterion alone is Sufficient to classify a case.

N = All “N” criteria in the same column are Necessary to classify a case. A number following an “N” indicates that this criterion is only required for a specific disease/condition subtype (see below).

A = This criterion must be absent (i.e., NOT present) for the case to meet the classification criteria.

O = At least one of these “O” (Optional) criteria in each category (e.g., clinical evidence and laboratory evidence) in the same column—in conjunction with all “N” criteria in the same column—is required to classify a case. (These optional criteria are alternatives, which means that a single column will have either no O criteria or multiple O criteria; no column should have only one O.) A number following an “O” indicates that this criterion is only required for a specific disease/condition subtype. [Use the following numbers to indicate different disease/condition subtypes (e.g., cutaneous anthrax vs. inhalational anthrax; type of arbovirus; foodborne botulism vs. wound botulism); delete if not needed.]

1 =

2 =


3 =

4 =


Appendix. Examples of types of information that could be used for criteria to distinguish a new case from duplicates, recurrence, persistent state, carrier state, acute versus chronic state, recrudescence, and relapse.
(a) time periods between repeated lab results for the same pathogen or environmental hazard --Note: It may be useful to define a hierarchy of dates to consider for the starting point for the repeated measures, since some dates may not be available to surveillance staff;

(b) sites of infection;

(c) exposure and travel history as it relates to dates of illness onset, diagnosis, lab tests, or hospitalization; and

(d) whether the condition was successfully treated.


CSTE National Office Staff can provide examples of criteria used by health jurisdictions and CDC programs.

Appendix 1: ICD codes




ICD-9-CM Diagnosis Code and Injury Cause E-Codes Explicitly Involving or Inclusive of Carbon Monoxide (CO) Poisoning

Type

CDC APRHB

Maine

Consensus

986

Toxic effect of carbon monoxide

1 Explicit

Confirmed

Confirmed or Probable

Probable?

E868.3

Accidental poisoning by carbon monoxide from incomplete combustion of other domestic fuels

1 Explicit

Confirmed or Probable

Confirmed or Probable

Probable?

E868.8

Accidental poisoning by carbon monoxide from other sources

1 Explicit

Confirmed or Probable

Confirmed or Probable

Probable?

E868.9

Accidental poisoning by carbon monoxide from an unspecified source

1 Explicit

Confirmed

Confirmed or Probable

Probable?

E952.1

Self-inflicted poisoning by other carbon monoxide source

1 Explicit

Confirmed

Confirmed

Probable?

E982.1

Undetermined cause of poisoning by other carbon monoxide source

1 Explicit

Probable

Probable

Probable

E868.2

Accidental poisoning by motor vehicle exhaust gas not elsewhere classifiable

2 Explicit

Probable

Probable

Probable

E952.0

Self-inflicted poisoning by motor vehicle exhaust gas

2 Explicit

Probable

Probable

Probable

E982.0

Undetermined cause of poisoning by motor vehicle exhaust gas

2 Explicit

Probable

Probable

Probable

E818.x

Other noncollision motor vehicle traffic accident, including accidental poisoning from exhaust gas

3 Inclusive

Suspected

Suspected

Suspected

E825.x

Other motor vehicle nontraffic accident of other and unspecified nature, including accidental poisoning from CO

3 Inclusive

Suspected

Suspected

Suspected

E844.x

Other specified air transport accidents, including poisoning by CO while in transit

3 Inclusive

Suspected

Suspected

Suspected

E867

Accidental poisoning by gas distributed by pipeline, or CO from combustion of such gas

3 Inclusive

Suspected

Suspected

Suspected

E868.0

Accidental poisoning by liquefied petroleum gas in mobile containers, or CO from combustion of such gas

3 Inclusive

Suspected

Suspected

Suspected

E868.1

Accidental poisoning by other/unspecified utility gas, or CO from combustion of such gas

3 Inclusive

Suspected

Suspected

Suspected

E890.2

Other smoke and fumes from conflagration in a private dwelling, including CO

3 Inclusive

Suspected

Suspected

Suspected

E891.2

Other smoke and fumes from conflagration in other building, including CO

3 Inclusive

Suspected

Suspected

Suspected

E838.x

Other and unspecified water transport accident, including accidental poisoning by bases or fumes on ship

4 Inclusive, unmentioned




Suspected

Suspected

E951.0

Self-inflicted poisoning by gases in domestic use, pipeline

4 Inclusive, unmentioned

Suspected

Suspected

Suspected

E951.1

Self-inflicted poisoning by gases in domestic use, LPG (mobile)

4 Inclusive, unmentioned

Suspected

Suspected

Suspected

E951.8

Self-inflicted poisoning by gases in domestic use, other utility gas

4 Inclusive, unmentioned

Suspected

Suspected

Suspected

E958.1

Self-inflicted injury by burns, fire

4 Inclusive, unmentioned







Suspected

E962.2

Homicidal assault by poisoning from other gases and vapors

4 Inclusive, unmentioned

Suspected

Suspected

Suspected

E968.0

Homicidal assault by fire

4 Inclusive, unmentioned

Suspected

Suspected

Suspected

E981.0

Poisoning by gases in domestic use, undetermined intent, pipeline

4 Inclusive, unmentioned

Suspected

Suspected

Suspected

E981.1

Poisoning by gases in domestic use, undetermined intent, LPG (mobile)

4 Inclusive, unmentioned

Suspected

Suspected

Suspected

E981.8

Poisoning by gases in domestic use, undetermined intent, other utility gas

4 Inclusive, unmentioned

Suspected

Suspected

Suspected

E988.1

Undetermined cause of injury by fire, burns

4 Inclusive, unmentioned

Suspected

Suspected

Suspected

987

Toxic effect of other gases, fumes or vapors

Inclusive, unmentioned

Suspected




Suspected

E869.9

Accidental poisoning by other gases or vapors, unspecified

Inclusive, unmentioned

Suspected

Suspected

Suspected

E952.9

Self-inflicted poisoning by other gases or vapors, unspecified

Inclusive, unmentioned

Suspected

Suspected

Suspected

E979.3

Terrorism involving fires, including asphyxia

Inclusive, unmentioned







Suspected

E972, E978

Legal intervention or execution including asphyxiation by gas

Inclusive, unmentioned







Suspected

Legend: The table above is a supplement to Table VII, and should not be used independently of Table VII.



ICD-10-CM Codes Explicitly Involving or Inclusive of Carbon Monoxide (CO) Poisoning

Type

Maine

Consensus

T58.x

Toxic effect of carbon monoxide from all sources

Explicit

Confirmed or Probable

Probable?

Legend: The table above is a supplement to Table VII, and should not be used independently of Table VII.



ICD-10 Cause of Death Codes Explicitly Involving or Inclusive of Carbon Monoxide (CO) Poisoning

Type

Maine

Consensus

T58.x

Toxic effect of carbon monoxide from all sources

Explicit

Confirmed

Confirmed

X47.x

Accidental poisoning by other gases and vapors, including CO

Inclusive

Suspected

Suspected

X67.x

Intentional self-poisoning by and exposure to other gases and vapors, including CO

Inclusive

Suspected

Suspected

X00.x -X09.x

Accidental exposure to fire, smoke, and flames

Inclusive, unmentioned




Suspected?

X76.x

Intentional self-injury due to fire, smoke, and flames

Inclusive, unmentioned




Suspected?

X88.x

Assault by gases and vapors

Inclusive, unmentioned




Suspected?

X97.x

Assault by fire, smoke, and flames

Inclusive, unmentioned




Suspected?

Y17.x

Poisoning by and exposure to other gases and vapors, of undetermined intent

Inclusive

Suspected

Suspected

Y26.x

Exposure to fire, smoke, and flames of undetermined intent

Inclusive, unmentioned




Suspected?

Y36.3

War operations involving fires, conflagrations including asphyxia from fire

Inclusive, unmentioned




Suspected?

Y35.2, Y35.5

Legal intervention or execution including asphyxiation by gas

Inclusive, unmentioned




Suspected?

Legend: The table above is a supplement to Table VII, and should not be used independently of Table VII.


1 Use only for diseases that are not healthcare-associated infections (HAI) reported through NHSN. For HAI, use the Template for Placing Healthcare-Associated Diseases or Conditions Under National Surveillance through the National Healthcare Safety Network.

Council of State and Territorial Epidemiologists



Position Statement Template: Standardized Surveillance for Diseases or Conditions, Revised 2013


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