QSurveillance: Supporting Public Health Emergencies Julia Hippisley-Cox On behalf of QSurveillance...

QSurveillance:

Supporting Public Health Emergencies

Julia Hippisley-Cox

On behalf of QSurveillance team

EMIS NUG, Warwick, 2009

Outline for QSurveillance Presentation

Overview of

- Its role in various emergencies in last 5 years

- Critical data reporting for Swine Flu Pandemic

- CMO’s most recent national briefing

- Proposal for Vaccine Safety Study

September 2009

Acknowledgements

EMIS practices

David Stables

Andy Whitwam

Sean Riddell

Fiona Baker

Debbie Walton

INS (for help with disaster recovery July 09)

John Croasdale

HPA

Gillian Smith

Alex Elliott

Sally Harcourt

Sue Smith

Liam Donaldson (slides)

Largest real time surveillance system worldwide (23m+patients)

Only system to be able to report to PCT

Used to monitor seasonal outbreaks of disease e.g. influenza, norovirus

Real time response to public health incidents

Compliments NHS Direct, RCGP, National Pandemic Service

Influenza virus particles

Flooding, Oxfordshire, 2007 © HPA, Jane Bradley

QSurveillance real-time surveillance

QSurveillance

Core part of the Emergency Response. Reports to

• HPA and HPU• Department of Health • CMO’s Office• Cobra• WHO• Academic Modellers

Used to make national and local policy decisions

Also used for reassurance

Examples: Ricin and London Bombings

Examples: Heatwaves

Examples: Buncefield

Examples: Avon Floods 2007

September 2009

Examples: Pandemic 2009

In the beginning…

0

10

20

30

40

50

60

Rat

e pe

r 10

0000

2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52

Week

UK 2008 UK 2009

(Database version 1)

Copyright QRESEARCH 2009Data source: QSurveillance (weekly data) - 27 Apr 2009

All patients all agesInfluenza like illness rate per 100000 population in the UK

Media ‘frenzy’?

0

10

20

30

40

50

60

Rat

e pe

r 10

0000

2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52

Week

UK 2008 UK 2009


Copyright QRESEARCH 2009Data source: QSurveillance (weekly data) - 1 Jun 2009


September 2009

Examples: Pandemic 2009, the ‘first wave’

0

50

100

150

200

250

Rat

e pe

r 10

0000

2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52

Week

UK 2008 UK 2009


Copyright QRESEARCH 2009Data source: QSurveillance (weekly data) - 31 Aug 2009


September 2009

Examples: Pandemic 2009, daily consultation rates

0

20

40

60

80

Rat

e pe

r 10

0000

28jun2009 05jul2009 12jul2009 19jul2009 26jul2009 02aug2009 09aug2009 16aug2009 23aug2009

Day

Crude daily rate 7-Day Moving Avg.


Copyright QRESEARCH 2009Data source: QSurveillance (daily data) - 24 Aug 2009


Age-specific ILI

0

200

400

600

Rat

e pe

r 10

0000

2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52

Week

under 1 year

1-4 years

5-14 years

15-24 years

25-44 years

45-64 years

65-74 years

75+ years


Copyright QRESEARCH 2009Data source: QSurveillance (weekly data) - 31 Aug 2009

by age bandInfluenza like illness rate per 100000 population in 2009 in the UK

QS regional data

0

10

20

30

40

50

60

Rat

e pe

r 10

0000

2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52

Week

North East

North West

Yorks. & Humberside

East Midlands

West Midlands

East of England

London

South East Coast

South Central

South West


Copyright QRESEARCH 2009Data source: QSurveillance (weekly data) - 29 Jun 2009

All patients all agesInfluenza like illness rate per 100000 population in 2009 by SHA

April 27 2009 - daily reporting

Daily NHS Direct calls

Cold/flu; fever; cough

Daily QS consult

ILI; URTI/LRTI; pneumonia

Weekly QS GP consult

ILl; URTI/LRTI; pneumonia

Examples: Pandemic 2009, England and Wales

Weekly consultations per 100,000 for ILI by PCT2009 week 27

No Data (5)over 130 (5)101 to 130 (3)

71 to 100 (9)51 to 70 (4)21 to 50 (28)

0 to 20 (97)

(C) Crown Copyright & Database Right 2009. Ordnance Survey Licence 100016969

QSurveillance (R) database version 1


No Data (4)over 130 (26)101 to 130 (14)

71 to 100 (22)51 to 70 (18)21 to 50 (49)

0 to 20 (18)




No Data (6)over 130 (113)101 to 130 (14)

71 to 100 (11)51 to 70 (5)21 to 50 (1)

0 to 20 (1)



Examples: Pandemic 2009, daily QSurveillance maps West Midlands

Wolverhampton City

Coventry TeachingSolihull

Heart of Birmingham TeachingDudley

Birmingham East and North

Herefordshire

South Birmingham

Shropshire County

Walsall Teaching

Telford and Wrekin

Sandwell

North Staffordshire

Stoke on Trent

South Staffordshire

Worcestershire

Warwickshire


No Data (0)over 130 (3)101 to 130 (1)

71 to 100 (2)51 to 70 (0)21 to 50 (8)

0 to 20 (3)

(C) Crown Copyright & Database Right 2009. Ordnance Survey Licence 100016969.


Wolverhampton City




Herefordshire

South Birmingham

Shropshire County

Walsall Teaching

Telford and Wrekin

Sandwell

North Staffordshire

Stoke on Trent

South Staffordshire

Worcestershire

Warwickshire


No Data (0)over 130 (6)101 to 130 (3)

71 to 100 (4)51 to 70 (1)21 to 50 (3)

0 to 20 (0)



Wolverhampton City




Herefordshire

South Birmingham

Shropshire County

Walsall Teaching

Telford and Wrekin

Sandwell

North Staffordshire

Stoke on Trent

South Staffordshire

Worcestershire

Warwickshire


No Data (0)over 130 (16)101 to 130 (0)

71 to 100 (1)51 to 70 (0)21 to 50 (0)

0 to 20 (0)



Islington

Hammersmith and Fulham

Havering

KingstonBromley

Greenwich Teaching

Barnet

Hillingdon

Enfield

Barking and Dagenham

City and Hackney Teaching

Tower Hamlets

Newham

Haringey Teaching

Ealing

Hounslow

Brent Teaching

Harrow

Camden

Croydon

Kensington and ChelseaWestminster

LambethSouthwark

LewishamWandsworth

Richmond and Twickenham

Sutton and Merton

RedbridgeWaltham Forest

Bexley


No Data (1)over 130 (2)101 to 130 (2)

71 to 100 (7)51 to 70 (3)21 to 50 (12)

0 to 20 (4)



Islington


Havering

KingstonBromley

Greenwich Teaching

Barnet

Hillingdon

Enfield



Tower Hamlets

Newham

Haringey Teaching

Ealing

Hounslow

Brent Teaching

Harrow

Camden

Croydon


LambethSouthwark

LewishamWandsworth


Sutton and Merton


Bexley


No Data (1)over 130 (16)101 to 130 (6)

71 to 100 (3)21 to 50 (4)

0 to 20 (1)



Islington


Havering

KingstonBromley

Greenwich Teaching

Barnet

Hillingdon

Enfield



Tower Hamlets

Newham

Haringey Teaching

Ealing

Hounslow

Brent Teaching

Harrow

Camden

Croydon


LambethSouthwark

LewishamWandsworth


Sutton and Merton


Bexley


No Data (2)over 130 (26)101 to 130 (1)

71 to 100 (1)51 to 70 (1)21 to 50 (0)

0 to 20 (0)



Pandemic 2009QSurveillance maps London

Usefulness of data?

Following the change to ‘national mitigation’, focus turned to syndromic surveillance

At local level, syndromic data used to determine ‘hot spots’ and change policy

Syndromic data used to model case estimates

Daily data feed to HPA sitrep, DH, CMO

Swine Flu Vaccine Safety StudyReal time evaluation of vaccine safety

Examine at about 30 serious adverse events

- Anaphylaxis

- Steven Johnson syndrome

- Guillain Barre syndrome

Need very large sample to get results quickly enough

Planning to recruit EMISWeb practices

Volunteers for pilot welcome in due course

Qsurveillance portal

We had to set up emergency web portal for the HPA and CMO, modellers in July 09

Extending this so practices can use it

See their own data

Draw comparisons between areas – PCTs, SHAs etc

http://qsurveillance.qresearch.org

http://qsurveillance.qresearch.org/

QSurveillance: Supporting Public Health Emergencies Julia Hippisley-Cox On behalf of QSurveillance...

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