Syndromic Surveillance State health departments have access to the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE), a syndromic surveillance pro- gram that monitors counts of reasons for ED visits (i.e., chief complaints) (Burkom et al., 2021; Centers for Disease Control and Preven- tion, 2022). The ESSENCE program incorpo- rates statistical methods to detect anomalies in data and provides alerts and warnings that can guide eorts to determine if the trends require further attention or intervention. ESSENCE was used to monitor trends in ED visits during the month after the incident, map ZIP Code areas with the largest numbers of ED vis- its, and specify which chief complaints (e.g., respiratory, mental health) increased in these areas. As the facility was near the Wisconsin border, the Wisconsin Department of Health Services also queried ESSENCE using the same criteria for ED visits related to the fire during June 14–July 1, 2021. General Health Survey Using a general health survey to assess the general public, the investigation team exam- ined the association of residents’ reported con- tact with material (i.e., smoke, dust, debris) or report of smelling an odor with any reported new or worsening symptom within the 2 weeks prior to survey completion. The inves- tigation team designed an electronic survey that was adapted from survey forms available from ATSDR’s ACE Toolkit (ATSDR, 2014; Duncan & Orr, 2016) and Epi Contact Assess- ment Symptom Exposure (Epi CASE) Toolkit (ATSDR, 2020) to evaluate the human health eects of the fire in the nearby population. The survey asked about demographic characteris- tics, residential distance from the facility, con- tact with material, smelling an odor, healthcare use, and new or worsening symptoms within the 2 weeks prior to survey completion. Demographic characteristics included age, gender, race, and ethnicity. Age was calcu- lated from date of birth and categorized as 0–19, 20–44, 45–64, and ≥65. Respondents selected one option for gender: female, male, transgender, or other. Respondents self- reported race from a list of options (White, Black or African American, Asian, American Indian or Alaska Native, Native Hawaiian or Pacific Islander, Other) and were considered “Multiracial” if they selected more than one
TABLE 1
Characteristics of General Health Survey Respondents by Symptom Status and Overall and Characteristics of the General Population From 11 ZIP Codes, Winnebago County, Illinois, July 2021
Characteristic
Asymptomatic Respondents ( n = 1,109) # (%)
Symptomatic Respondents ( n = 911) # (%)
Respondents Overall ( N = 2,020) # (%)
General Population From 11 ZIP Codes ( N = 240,043) # (%) 61,626 (25.7) 72,678 (30.3) 64,305 (26.8) 41,434 (17.3)
Age (years) 0–19
17 (1.5)
11 (1.2)
28 (1.4)
20–44 45–64
370 (33.4) 492 (44.4) 225 (20.3)
363 (39.8) 400 (43.9) 135 (14.8)
733 (36.3) 892 (44.2) 360 (17.8)
≥65
Missing
5 (0.5)
2 (0.2)
7 (0.3)
–
Gender or Sex a Female
664 (59.9) 431 (38.9)
613 (67.3) 272 (29.9)
1,277 (63.2)
123,580 (51.5) 116,463 (48.5)
Male
703 (34.8)
Transgender
1 (0.1) 1 (0.1)
5 (0.5) 5 (0.5)
6 (0.3) 6 (0.3)
– – –
Other
Prefer not to answer
12 (1.1)
16 (1.8)
28 (1.4)
Race
White
967 (87.2)
777 (85.3)
1,744 (86.3)
188,983 (78.7) 30,516 (12.7)
Black or African American
25 (2.3)
40 (4.4)
65 (3.2)
Other Asian
21 (1.9) 31 (2.8) 15 (1.4)
21 (2.3)
42 (2.1) 40 (2.0) 27 (1.3)
4,396 (1.8) 7,291 (3.0) 8,075 (3.4)
9 (1.0)
Multiracial
12 (1.3)
American Indian or Alaska Native Native Hawaiian or Pacific Islander Prefer not to answer
2 (0.2)
6 (0.7)
8 (0.4)
757 (0.3)
0 (0)
0 (0)
0 (0)
25 (<0.1)
48 (4.3)
46 (5.0)
94 (4.7)
–
Hispanic or Latino No
1,064 (95.9)
855 (93.9)
1,919 (95.0)
209,996 b (87.5)
Yes
45 (4.1)
56 (6.1)
101 (5.0)
30,047 (12.5)
continued on page 10
for Toxic Substances and Disease Registry [ATSDR], 2016; Duncan, 2014). On June 25, 2021, the Illinois Department of Public Health invited ATSDR to conduct an ACE investigation (Surasi et al., 2021). This article presents findings from the ACE investigation of a chemical fire in Winnebago County, Illinois. The investigation included several public health tools to examine the magnitude, geography, and nature of the
health eects of the fire in nearby communi- ties and assessed exposures and health out- comes among first responders. Methods This ACE investigation used syndromic sur- veillance to monitor emergency department (ED) visits, a general health survey to assess the general public, and a first responders health survey to assess first responders.
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March 2023 • our5(l o- 5=0ro5me5;(l e(l;/
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