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is for Epi. Epidemiology basics for non-epidemiologists. Session IV Part I. Surveillance. Session Overview. Introduction to Public Health Surveillance Passive, active, and syndromic surveillance Communicable disease law Paper-based surveillance of reportable diseases

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is for Epi

Epidemiology basics

for non-epidemiologists


Session iv part i

Session IVPart I

Surveillance


Session overview
Session Overview

  • Introduction to Public Health Surveillance

    • Passive, active, and syndromic surveillance

    • Communicable disease law

    • Paper-based surveillance of reportable diseases

    • Applications and limitations

  • Federal Public Health Surveillance

    • CDC’s role

    • Data sources

    • Surveillance reporting examples


Session overview cont d
Session Overview (cont’d.)

  • Techniques for Review of Surveillance Data

    • Considerations when working with surveillance data

    • Access to data sources for rate numerators and denominators

    • Descriptive epidemiology

    • Graph and map surveillance rates


Today s learning objectives
Today’s Learning Objectives

  • Recognize the applications and limitations of current public health surveillance practices

  • Understand the function of three different types of surveillance: active, passive, and syndromic

  • Be familiar with federal public health surveillance systems relevant to epidemiology programs

  • Understand the reciprocal pathway of data exchange through county, state, and federal surveillance efforts

  • Recognize the major components of surveillance data analysis



What is surveillance1
What is Surveillance?

CDC: The ongoing systematic collection, analysis, and interpretation of health data, essential to the planning, implementation, and evaluation of public health practice, closely integrated with the timely dissemination to those who need to know.


Standardized data collection

County and state health departments and CDC who analyze data using statistical methods

-Physicians

-Laboratories

-STD clinics

-Community health clinics


Standardized data collection

County and state health departments and CDC who analyze data using statistical methods

-Physicians

-Laboratories

-STD clinics

-Community health clinics

Dissemination to those who need to know

Dissemination to those who need to know

-Public health officials

-Health directors

-Health policy officials


Standardized data collection

County and state health departments and CDC who analyze data using statistical methods

-Physicians

-Laboratories

-STD clinics

-Community health clinics

Dissemination to those who need to know

Dissemination to those who need to know

Change in public health practice (vaccination, reduction of risk factors, medical intervention, etc.)

-Public health officials

-Health directors

-Health policy officials

Public health planning and intervention


Standardized data collection

County and state health departments and CDC who analyze data using statistical methods

-Physicians

-Laboratories

-STD clinics

-Community health clinics

Dissemination to those who need to know

Public health evaluation

Dissemination to those who need to know

Change in public health practice (vaccination, reduction of risk factors, medical intervention, etc.)

-Public health officials

-Health directors

-Health policy officials

Public health planning and intervention


Nndss netss
NNDSS & NETSS

  • The National Notifiable Disease Surveillance System (NNDSS)

  • Disease-specific epidemiologic information

  • 60 nationally notifiable infectious diseases

  • 10 non-notifiable infectious diseases

  • The National Electronic Telecommunications System for Surveillance (NETSS)


Elements of surveillance
Elements of Surveillance

  • Mortality reporting – legally required

  • Morbidity reporting – legally required

  • Epidemic reporting

  • Timely reporting

  • Laboratory investigations

  • Individual case investigations

  • Epidemic field investigations

  • Analysis of data


Types of surveillance
Types of Surveillance

  • Passive

  • Active

  • Syndromic


Passive surveillance
Passive Surveillance

Laboratories, physicians, or other health care providers regularly report cases of disease to the local or state health department based on a standard case definition of that particular disease.


Communicable disease reporting passive surveillance
Communicable Disease Reporting:Passive Surveillance

Lab

Physician

Hospital

Public

CDC

Local

Health

Department

State


Recommended reportable diseases

Acquired Immunodeficiency Syndrome (AIDS) 

Anthrax

Arboviral neuroinvasive and non-neuroinvasive diseases

Botulism

Brucellosis

Chancroid

Chlamydia trachomatis, genital infections

Cholera

Coccidioidomycosis 

Cryptosporidiosis

Cyclosporiasis

Diphtheria

Ehrlichiosis

Enterohemorrhagic Escherichia coli

Giardiasis

Gonorrhea

Haemophilus influenzae, invasive disease

Hansen disease (leprosy)

Specific reportable diseases and conditions are mandated by state law, and may be different for every state.

Recommended Reportable Diseases


Active surveillance
Active Surveillance

Local or state health departments initiate the collection of specific cases of disease from laboratories, physicians, or other health care providers.


Communicable disease reporting active surveillance
Communicable Disease Reporting:Active Surveillance

Lab

Physician

Hospital

CDC

Local

Heath

Department

State


Active surveillance applications
Active Surveillance Applications

  • Outbreak investigations

  • Other times when complete case ascertainment is desired (e.g., research study)


Syndromic surveillance
Syndromic Surveillance

The ongoing, systematic collection, analysis, interpretation, and application of real-time indicators for disease that allow for detection before public health authorities would otherwise identify them.


What are indicators of disease
What are “indicators of disease?”

  • “Indicators”

    • Clinical signs that we can categorize into syndromes

    • NOT a specific diagnosis!

      Example:

      Cough + Sore throat + Fatigue + Fever = Influenza-Like Illness


Common syndromes under surveillance
Common Syndromesunder Surveillance

  • Gastroenteritis

  • Influenza-like illness (ILI)

  • Meningitis / Encephalitis

  • Rash / Fever

  • Botulinic

  • Hemorrhagic


Why do syndromic surveillance
Why Do Syndromic Surveillance?

  • Early detection of clusters in naturally occurring outbreaks or a BT event

    • Minimizes mortality & morbidity

  • Characterize outbreak

    • Magnitude, rate of spread, effectiveness of control measures

  • Quick investigation

  • Detection of unexplained deaths


Limitations of syndromic surveillance
Limitations of Syndromic Surveillance

  • Inadequate specificity: false alarms

    • Uses resources in investigation

  • Inadequate sensitivity: failure to detect outbreaks/BT events

    • Outbreak is too small

    • Population disperses after exposure, cluster not evident


Limitations of syndromic surveillance1
Limitations of Syndromic Surveillance

  • Costly

  • Staff expertise required

  • Formal evaluation of syndromic surveillance systems are incomplete



Applications
Applications

  • Establish public health priorities

  • Aid in determining resource allocation

  • Assess public health programs

    • Facilitate research

  • Determine baseline level of disease

  • Early detection of epidemics

    • Estimate magnitude of the problem

    • Determine geographical distribution


Establish public health priorities
Establish Public Health Priorities

  • Frequency

    • Incidence, prevalence, mortality, years of life lost

  • Severity

    • Case fatality rate, hospitalization, disability

  • Cost

    • Direct, indirect


Resource allocation
Resource Allocation

TUBERCULOSIS: Reported cases per 100,000 population,

United States and U.S. territories, 2002

Source:http://www.cdc.gov/dphsi/annsum/index.htm


Assess public health programs
Assess Public Health Programs

Gonorrhea: reported cases per 100,000 population,

United States, 1987 - 2002

Data Graphed by Race and Ethnicity

Data Graphed by Gender

Source:http://www.cdc.gov/dphsi/annsum/index.htm


Determine Baseline Rates

TUBERCULOSIS

among U.S.-born and foreign-born persons, by year, United States, 1990-2002

*For 120 cases, origin of patients was unknown.




Limitations
Limitations

  • Uneven application of information technology

    • Paper-based versus Electronic

  • Timeliness

    • Reporting time requirement

    • Reporting burden

  • Completeness

    • Unreported cases

    • Incomplete reports


Limitations: Multiple Categorical Systems

Current Situation

Program Specific Reports and Summaries

MMWR Annual Summaries

MMWR Weekly Tables

Statistical Surveys for Chronic Diseases, Injuries and Other Public Health Problems

STD*MIS

TIMS

NNDSS

EIP Systems

PHLIS

HARS

CDC

Varied communications methods and security - specific to each system - including diskettes, e-mail, direct modem lines, etc.

Reporting by Paper Form, Telephone & Fax

Data Sources

State Health Dept

EIP Systems

HARS

STD*MIS

TIMS

NETSS

PHLIS

Physicians

Varied communications methods and security - specific to each system- including paper forms, diskettes, e-mail, direct modem lines, etc.

Chart Review

Lab Reports

HARS

STD*MIS

TIMS

NETSS

EIP Systems*

PHLIS

* EIP Systems (ABC, UD, Foodnet)

City/County Health Department

STD*MIS (Optional at the Clinic)

TIMS (Optional

at the Clinic)


National electronic disease surveillance system nedss
National Electronic Disease Surveillance System (NEDSS)

  • NEDSS is not a surveillance system

  • Electronically integrates existing surveillance systems for easy data collection, storage and access

  • Security to meet confidentiality needs


Surveillance challenges at the state level
Surveillance Challenges at the State Level

  • Quality of the data

  • Balancing priorities

  • Discrepancies and perspectives

  • Translating data into information


Quality of the data
Quality of the Data

  • Completeness of case ascertainment

  • Completeness and accuracy of case information

  • Timeliness of reports

  • Sentinel indicators

‘Tip of the iceberg’


Discrepancies and perspectives
Discrepancies and Perspectives

  • Clinical vs surveillance case definitions

  • Cases ‘worked’ vs cases ‘counted’

  • Place of exposure, residence, diagnosis

  • Re-infection or duplicate report

  • Stats by date of onset, diagnosis, report


Translating data into information
Translating Data into Information

  • Provides the basis for public health action

  • Requires sound analysis and interpretation

  • Extracts meaningful, actionable findings

  • Requires clear presentation of complex issues


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