Bioterrorism Surveillance

History of Bioterrorism Surveillance in Missouri
Missouri was the first state to provide statewide bioterrorism surveillance in response to the terrorist attacks of September 11, 2001. The original version, High Alert Surveillance System (HASS), was implemented in October of 2001 and by the summer of 2003, there were 811 reporting sites volunteering their resources to report emergency department (ED) and urgent care visit and other data to the state for the purpose of monitoring possible outbreaks.

The HASS system was designed to detect and assess public health threats, specifically bioterrorism events, and aid communication about those threats to the appropriate personnel. The goal of these activities was that by implementing timely interventions, appropriate responses could be initiated in order to minimize the event’s impact on Missourians and save lives.  In addition to early event detection, the HASS system can provide situational awareness during known health events. Public health authorities can use this information to assess the magnitude of health events and guide decision-making on containment and prevention activities.

Bioterrorism Surveillance Today
The original HASS system is now much smaller in scope, with only about 40 sites remaining, and is now referred to as the Bioterrorism Surveillance (BTS) System, or BT Surv.  The main reason for the decreasing number of sites is that many voluntary reporters also met criteria established in state law 19 CSR 10-33.040, which requires certain hospitals to report ED data electronically to DHSS specifically for syndromic surveillance.  These electronic data are utilized by the Missouri ESSENCE Project for early event detection and situational awareness (see links below for more information).  

As its name suggests, BTS was originally conceived as a bioterrorism-focused detection system.  Since 2001, many other applications of these data have become apparent.  The Public Health Event Detection and Assessment (PHEDA) Program is now responsible for overseeing BTS.   The PHEDA name reflects a new mission to detect and assess health events of all kinds including naturally occurring outbreaks, natural disasters, or intentional chemical or biological releases.
 
Future Plans for BTS
Currently, BTS is made possible by the voluntary participation of sentinel sites, whose dedicated staff provide daily reports to DHSS.  We plan to expand the BTS system to maintain surveillance of institutions (e.g., schools, rural health facilities, nursing homes) that may lack the financial and/or technological resources to report real-time data electronically for the ESSENCE Project.

Data Release Policy
BTS sentinel data is considered public record, as there are no state or federal laws that prohibit sharing the data with partners and the public.  In rare cases, BTS aggregate data contains certain direct or indirect identifying information (for example, a patient name or ID number is included in the Other Information section). Patient level records are not public information, and may be shared only with other public health authorities and coinvestigators of a health study if they abide by the same confidentiality restrictions required by the Department of Health and Senior Services under sections 192.067, RSMo.

BT Surveillance Hospitals Map

Hospital Electronic Syndromic Surveillance

Missouri ESSENCE