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Story from the Field


Name of Health Department/Agency: Boston Public Health Commission
State: MA
Date Added: 01/26/2010
Themes: Surveillance and Epidemiology
Issue Summary: Boston used its surveillance system to improve H1N1 situational awareness, and to help make response decisions.
Description of Issue(s):

Over the last several years, the Boston Public Health Commission has worked tirelessly to implement and refine a surveillance system that is both nationally-recognized, and the most comprehensive public health surveillance system in Massachusetts. That system, developed by the BPHC's Communicable Disease Control Division, captures important streams of data and has contributed to evidence-based decision making throughout the 2009 H1N1 response.

Actions taken to address the issue(s): Through case investigation, reviewing information from its syndromic and emergency room surveillance systems, and by daily reviews of EMS trip data, school attendance data and reports from college health services, BPHC officials have developed a more complete picture of how the epidemic is impacting city residents. This improved situational awareness for public health officials, but it also helped quickly identified disparities in the burden of illness. (During the spring wave of 2009 H1N1, 3 out 4 hospitalized patients were either black or Latino.) Sharing this data also helped improve ongoing communication efforts between the Commission and health care providers in Boston. The information also helped identify gaps and areas where additional patient resources were needed, and assisted the development of prevention and outreach strategies. One such specific example found during case investigations was the recurring complaint of parents who were unable to locate liquid oseltamivir (Tamiflu) after it was prescribed for their children. Health officials were able to act on that information before the shortage of such medication had become widely reported by the Centers for Disease Control & Prevention.
Outcomes that resulted from actions taken: Through its skillful use and interpretation of surveillance data during the 2009 H1N1 response, BPHC has been able to improve decision making, strengthen communication with its partners, and identify disparities in the burden of disease among city residents. It has also helped identified response gaps, and subsequent corrective actions.

A sample BPHC flu surveillance report can be viewed in NACCHO's H1N1 toolkit at: http://www.naccho.org/toolbox/tool.cfm?id=1920

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