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Welcome to the blog for the International Society for Disease Surveillance. Read, and share your views on news and opinion from the leadership of the Association. Do you have an idea for a blog? Send your idea to Mark Krumm


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Top tags: NSSP  Steering Committee  Amanda  Gil  Harold  Morse  opioid 

Meet Harold Gil, (Former) NSSP Steering Committee Board Member

Posted By Mark Krumm, Friday, July 7, 2017

Harold GilWith deep appreciation for his service, ISDS announces the departure from the Steering Committee as of September, 2017...

Harold is Epidemiologist - Surveillance with the Marion County, Indiana Public Health Department. We asked him to answer a few questions that will help us to get to know him....

How did you first learn about disease surveillance and when did you decide that it was an area of interest for you?

I first learned about disease surveillance while doing a summer internship at the CDC Global AIDS Program station in Guatemala. As soon as I opened the datasets I had to work with, I was pretty shocked by the fact that many important fields that I needed for my analysis had mostly missing values. I thought about this and realized that program decisions for addressing HIV/AIDS are being made off of largely incomplete data. I realized that this must be happening all over the world to some extent and that the public health field is losing out on important information it needs to have an optimal impact. At the same time, I was serendipitously asked to translate a document summarizing needs from other country programs in the Caribbean-American region and most countries reported their number one need as “informatics capacity”. Thus, I decided that I would go into the public health informatics field to maximize my impact in public health.

What do you enjoy most about your job?

I’m a surveillance epidemiologist. I get to build neat applications that allow me to make better use of the data I work with. I like that the fact that the grant I work under (NSSP) allows me to use much of my time to help others develop their technical abilities or to create tools that others may use. I get to collaborate with many people on different projects and it is clear to me that we make an impact in the field of health surveillance. At the same time, many of the people that I work with make work fun.

What is your proudest professional accomplishment or achievement (related to disease surveillance)?

When I was an APHIF fellow I led a project called BioSense User Community Extension Project (UCEP); its goal was to develop tools to help us get good measures our BioSense data’s quality. Several local and state jurisdictions were involved in the project and we split up tasks amongst ourselves. We accomplished a lot as seen by the products we put out (scripts, example output, user guide) and I’m very proud of how highly collaborative the whole thing was.

 What is the biggest issue in disease surveillance (in your opinion)?

I’d say it is a mixture between having such burdensome restrictions on data sharing and finding additional ways to leverage data. I think these go hand-in-hand because by being able to share more data, we can get access to more as well, and that can allow us to solve more problems we encounter in health surveillance.   

What is one thing that people would be surprised to learn about you?

In my spare time I like to read math books or as I like to call them - “novels”. I’ll read a neat theorem, with a long island at hand, and think “Hmm… an interesting development” or a challenging proof and say to myself, “My my, that escalated quickly”. I’m totally joking here. Just like learning to program can be fun because it’s like solving different puzzles, learning math can also be highly fulfilling if you enjoy tackling logic puzzles.

If you were not an epidemiologist, what would you be?

Tough question because I have many interests… Magic Harold? I think the idea of being an applied mathematician sounds fun; though the reality of it for me might end up feeling like a highly unpleasant experience!

Tags:  Gil  Harold  NSSP  Steering Committee 

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Meet NSSP Steering Committee Member, Amanda Dylina Morse, MPH

Posted By Mark Krumm, Friday, June 30, 2017

Amanda Dylina MorseAmanda Dylina Morse, MPH is the Syndromic Surveillance Outreach and Policy Coordinator at the Washington State Department of Health, and a member of the NSSP Steering Committee. We asked her a few questions about her career and interests so you could get to know her. Here are her answers.


How did you first learn about disease surveillance and when did you decide that it was an area of interest for you?


I learned about syndromic surveillance accidentally when I was asked to work with a group in Bangladesh to help them analyze their clinical data. The project was a bit of a bust (I got dengue while in Dhaka doing some other work for them), but I was excited to learn more and took my current job when I graduated.


What do you do?


I handle outreach and policy for the Washington State syndromic surveillance program, which we call the Rapid Health Information NetwOrk (RHINO). Washington just passed a mandate for emergency departments to submit syndromic data to our state Department of Health, which has formed the bulk of my work.


What do you enjoy most about your job?


One of my tasks is facilitating ESSENCE trainings for our local health jurisdictions and other partners. It’s exciting to hear each group’s hopes for how to use the data as we onboard more facilities and its gratifying to watch new users become more confident.


What excites you in the work you do?


I love spending time working on new use cases (especially for injury surveillance). Clinical data is such a rich source of information.


Who or what inspires you professionally? 


My MPH advisor Dr. Ian Painter has been an excellent example for being both kind and creative. He’s fantastically talented person, but so quiet about it and always so willing to puzzle out problems with students or colleagues.


What is your proudest professional accomplishment or achievement (related to disease surveillance)?


I was very proud when our mandate passed through our Legislature. It took a lot of work to bring all the stakeholder groups together and get the language to a place where everyone was happy with it.


How long have you been involved with ISDS?


Since December 2016.


Why are you an ISDS member?


I think collaboration is important to improve practice. The closer groups from around the country and outside the US work together, the better we’ll all be positioned to improve public health.


What do you value most about your ISDS membership? 

I enjoy the variety of webinars each month and the opportunities to learn from all the good things others around the country are doing.


What is the biggest issue in disease surveillance (in your opinion)?


For Washington State, I’d say onboarding our facilities. We have counties now that have syndromic data for the first time, but we’re about 27% of our emergency departments in production now, so there’s still lots of work to be done.


What is one thing that people would be surprised to learn about you?


People who know me well probably aren’t surprised about it, but I studied Latin for nine years and thought that I would be an archivist in a museum. I was particularly interested in numismatics (the study of coins and currency). Wealthy Romans used minting as one of their favorite ways to show their power and piety (piety for Romans was more about civic duty than how we conceptualize it) and you can learn a lot about what people valued by looking at what they stamped onto copper and mass distributed.


If you could meet anyone living or deceased, who would it be?


Secretary Hillary Clinton or Livia Drusilla.


If you were not a human, what would you be?

A cat.


Tags:  Amanda  Morse  NSSP  Steering Committee 

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Opioids: Updates Prevention for States and Data-Driven Prevention Initiative/CDC Awardee Meeting May, 2017

Posted By Amy Ising, Wednesday, May 17, 2017

Last week I had the opportunity to attend the PfS and DDPI Awardee Meeting in Atlanta, Georgia.  These meetings were held concurrently with another awardee meeting, the Enhanced State Surveillance of Opioid-Involved Morbidity and Mortality - ESOOS  These three programs support various initiatives across 44 states to address the opioid overdose epidemic.  Presenters shared various approaches to surveillance for opioid overdoses and I have compiled a brief list of my takeaways, questions and next steps.

Several states participating in ESOOS are providing emergency department (ED) data on opioid-related ED visits to the CDC Division of Unintentional Injury Prevention via the National Syndromic Surveillance Program ESSENCE platform. This is an exciting approach to sharing ED data with CDC programs not directly affiliated with NSSP and hopefully one that can be expanded in the future as time and resources permit.

The CDC Division of Unintentional Injury Prevention is working with NSSP ESSENCE to develop opioid-related indicators to use in ESSENCE. The first definition added is for heroin overdose ( and additional indicators are under development. In addition, this collaboration plans to collect and incorporate locally-developed definitions into NSSP ESSENCE for all ESSENCE participants to use as they see fit.

There are tremendous opportunities for similar collaborations among syndromic surveillance and injury epidemiologists at state and local levels.  Please share any best practices or barriers for collaborations across program areas with the ISDS Community of Practice.

The transition to ICD-10-CM on October 1, 2015 has created additional challenges in conducting surveillance for opioid overdoses in emergency department (ED) data in most states.  While the initial expectation was that hospitals would use the “T codes” for opioid overdoses (Poisoning by drugs, medicaments and biological substances), many ED visits with a chief complaint or triage note mentioning overdose do not have any poisoning diagnosis codes; instead they receive an “F code” (Mental and behavioral disorders due to psychoactive substance use).  Additional analyses are needed to identify why F codes are used instead of T codes; one hypothesis is that overdose patients who received naloxone prior to arrival in the ED and are stable upon arrival may receive an F code while those receiving naloxone in the ED receive a T code. 

Additional work is needed with natural language processing methods to take full advantage of the data in ED triage notes and EMS narratives.  While these data elements can provide invaluable contextual information related to overdoses and can help to identify overdose encounters that may not be identified through other submitted data elements, techniques that improve specificity and account for negation and historical information must be applied.

Several states are creating publicly-available dashboards that present a variety of opioid overdose indicators. Links to a few examples are below.


Rhode Island:



If you are interested in overdose surveillance issues, please consider joining the ISDS Overdose Surveillance Committee. More information is available at and a kick-off call is scheduled for June 2, 2017.

Amy Ising

NC DETECT Program Director

ISDS Board Member

Amy Ising is Immediate Past-President of ISDS



Tags:  opioid 

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Nurturing New Colleages in Public Health

Posted By Ann Kayser, MPH, Tuesday, April 11, 2017

My public health career began in December 2014. This was my first grown-up job after completing graduate school and I was excited to start; as all new graduates do, I possessed the blazing positivity that I could change the world by working in public health.

In these two years, much has changed, including a promotion. Around the time I was promoted to a manager position, I was asked by my fellowship mentor as our time came to a close, “What can others in the field do to help persons early in their careers?”

Although they may not know or realize it, new graduates need the guidance that public health veterans can provide; the knowledge, expertise, anecdotes, and charisma to navigate the world of public health surveillance that we have gained from our own years of experience in the field.

Upon examination, there are a few ways that I ask you to take the time to say “yes” and engage new public health employees:

1. Talk to us.

Set aside time every week or month to just talk. In the two years I have worked in public health, one of my most valued experiences has been learning from mentors in public health. These individuals take the time out of their schedules to put down their phones, look away from their computer screens and look me in the eyes. Actively being involved in the conversation at hand has taught me to also do the same when speaking with others and provide me with confidence to share my ideas and problems.

2. Don't step on our dream.

One of the best things (and sometimes most irritating to seasoned colleagues) about beginners in the public health world is they want to do good regardless of whether it has been tried before. When a person early in their career hits a challenge, they look for ways to change the challenge into a success. As someone who has been at an agency for a while, it is often difficult to not counter optimism and initiative with pessimism masquerading as realism. New employees have not been worn down and smoothed around the edges. Allow these individuals to maintain some of those sharp edges because sometimes - when hit against an opportunity – it sparks a fire for positive change.

3. Pay attention when we ask “Why?”

New public health employees provide the perfect opportunity for agencies to evaluate if the jobs being done are effective and to identify gaps in services provided. Often agencies do things because they "have always been done that way," but examining challenges with a new pair of eyes can create disruptive change for good. Define the end goal, not the step-by-step instructions. Allowing for new insight provides not only accountability and responsibility that may otherwise be avoided, but invests in the projects.

4. Be a Conduit.

Remember, we have yet to meet our future colleagues and collaborators in public health. Invite new employees to meetings with internal and external partners. This provides the opportunity to learn from people that come from different backgrounds, learn about emerging topics of interest and give other resources to reach out to.

While I may not be able to change the world through public health, I can try to make simple changes every day to help those starting their public health careers by engaging them and encouraging their dreams. Please consider, as public health veterans, making the same contribution to the future leaders of public health. After all, many of us went into public health to help others – why not start with those who chose the same passion?

Ann Kayser, MPH

Ann Kayser is a guest blog contributor. She is a Surveillance Epidemiologist for the Indiana State Department of Health.

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Make Your Own Music

Posted By Mark Krumm, Tuesday, February 7, 2017

In public health, we are so used to doing so much with so little, that we almost wear it like a badge of honor on our sleeves. And we have earned this badge. Public health aims to prevent, promote, and protect and these actions take tremendous work despite our ever-dwindling resources. Although we all deserve a pat on the back for continuing to accomplish such great feats with so little support, this is not a medal we should strive to obtain. We are not doing ourselves or the communities we serve any favors by being complacent with the level of support we receive. We in public health understand that prevention pays off financially in the long run. We need to put more effort and time into documenting those cost savings and explaining those savings to our non-public health partners and legislatures who play such a critical role in allocation of funds. As our leaders change both under our public health and medical tents and outside in the rest of the world, we need to explain what we do and why it is critical. Our surveillance work tells us what is weak, what is strong, and who needs help. We need to operate public health like the business that it is.

In the closing remarks of our annual conference in December, I shared a quote last year’s ISDS Board President Amy Ising found and it fits our society perfectly, ‘If you don’t toot your own horn, don’t complain that there’s no music.’ The quote is from Guy Kawasaki, an American marketing specialist, author, and Silicon Valley venture capitalist. He was one of the Apple employees originally responsible for marketing their Macintosh computer line in 1984. We all know how those marketing efforts have paid off for Apple.

Guy KawasakiI’ve had conversations where public health practitioners (especially those of us in the data world) have talked about how we can be introverted. I understand that completely. I am a numbers person too. But if we are to do great things with our numbers, we must learn how to sell what we have to offer. We have to make our own music because the outside world doesn’t realize we have a concert to offer anyone.

As we start a new year, I challenge you all to take steps in helping us make our own music. Tell someone outside of your health department how your data helps create the weekly flu report. Tell your child’s pediatrician how you know there is a pertussis outbreak in your area. Tell your local politicians how your data helps police and fire emergency responders plan and prepare for mass gatherings. Write a letter to the editor of your local paper. Jazz it up. Tell your public health story with your words as if you had to write a short and catchy tune that could interest others to want another song.

Toot your own horns.

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