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Overview of Uses for Public Health Surveillance. Daniel M. Sosin, M.D., M.P.H. Division of Public Health Surveillance and Informatics Epidemiology Program Office. Public Health Surveillance.

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overview of uses for public health surveillance

Overview of Uses for Public Health Surveillance

Daniel M. Sosin, M.D., M.P.H.

Division of Public Health Surveillance and Informatics

Epidemiology Program Office

public health surveillance
Public Health Surveillance
  • Ongoing, systematic collection, analysis, and interpretation of health-related data and dissemination for use in the planning, implementation, and evaluation of public health practice.
uses of public health surveillance
Uses of Public Health Surveillance
  • Estimate magnitude of the problem
  • Portray the natural history of a disease
  • Determine distribution and spread of illness
  • Detect outbreaks
  • Generate hypotheses, stimulate research
  • Evaluate control and prevention measures
  • Monitor changes in infectious agents
  • Detect changes in health practices
  • Facilitate planning
uses of public health surveillance4
Uses of Public Health Surveillance
  • Estimate magnitude of the problem
  • Portray the natural history of a disease
  • Determine distribution and spread of illness
  • Detect outbreaks
  • Generate hypotheses, stimulate research
  • Evaluate control measures
  • Monitor changes in infectious agents
  • Detect changes in health practices
  • Facilitate planning
shigellosis 1968 1998

15

10

Reported cases per 100,000 population

5

0

1968

1973

1978

1983

1988

1993

1998

Year

Shigellosis1968-1998

Source: CDC. Summary of notifiable diseases. 1998.

uses of public health surveillance6
Uses of Public Health Surveillance
  • Estimate magnitude of the problem
  • Portray the natural history of a disease
  • Determine distribution and spread of illness
  • Detect outbreaks
  • Generate hypotheses, stimulate research
  • Evaluate control measures
  • Monitor changes in infectious agents
  • Detect changes in health practices
  • Facilitate planning
slide7

160

National Center for Infectious Diseases (NCID) data*

National Electronic Telecommunications System for Surveillance (NETSS) data

140

TOXIC SHOCK SYNDROME (TSS)

United States, 1983-1998

120

Reported cases

100

80

60

40

20

0

1992

1989

Year (Quarter)

1983

1984

1986

1987

1988

1990

1991

1993

1994

1995

1996

1997

1998

*Includes cases meeting the CDC definition for confirmed and probable cases for staphylococcalTSS.

1985

uses of public health surveillance8
Uses of Public Health Surveillance
  • Estimate magnitude of the problem
  • Portray the natural history of a disease
  • Determine distribution and spread of illness
  • Detect outbreaks
  • Generate hypotheses, stimulate research
  • Evaluate control measures
  • Monitor changes in infectious agents
  • Detect changes in health practices
  • Facilitate planning
rate of hepatitis a united states 1998
Rate of Hepatitis AUnited States, 1998

NYC

DC

PR

NA

VI

GUAM

AM SAMOA

NA

NA

CNMI

>20.0

< 5.0

5.0–9.9

10.0–19.9

Source: CDC. Summary of notifiable diseases. 1998.

uses of public health surveillance10
Uses of Public Health Surveillance
  • Estimate magnitude of the problem
  • Portray the natural history of a disease
  • Determine distribution and spread of illness
  • Detect outbreaks
  • Generate hypotheses, stimulate research
  • Evaluate control measures
  • Monitor changes in infectious agents
  • Detect changes in health practices
  • Facilitate planning
botulism foodborne united states 1978 1998

110

100

90

80

70

60

50

40

30

20

10

0

Botulism (Foodborne)United States, 1978-1998

Laboratory-confirmed cases*

NETSS data

Outbreak caused by potato salad, NM

Outbreak caused by sautéed onions, IL

Outbreak caused bybaked potatoes, TX

Outbreak caused by fermented fish/sea products, AK

Reported cases

1978

1983

1988

1993

Year

1998

Source: CDC. Summary of notifiable diseases. 1998.

*Data from survey of state epidemiologists and directors of state public health laboratories.

Not yet available for 1998.

uses of public health surveillance12
Uses of Public Health Surveillance
  • Estimate magnitude of the problem
  • Portray the natural history of a disease
  • Determine distribution and spread of illness
  • Detect outbreaks
  • Generate hypotheses, stimulate research
  • Evaluate control measures
  • Monitor changes in infectious agents
  • Detect changes in health practices
  • Facilitate planning
slide13

MEASLES (Rubeola)

United States, 1963-1998

500

MEASLES — by year, United States, 1983–1998

450

30

25

400

20

Reported Cases (Thousands)

15

350

10

300

5

0

250

1983

1988

1993

1998

200

Year

150

100

50

0

1963

1968

1973

1978

1983

1988

1993

1998

Vaccine licensed

Reported cases (thousands)

Year

Source: CDC. Summary of notifiable diseases. 1998.

uses of public health surveillance14
Uses of Public Health Surveillance
  • Estimate magnitude of the problem
  • Portray the natural history of a disease
  • Determine distribution and spread of illness
  • Detect outbreaks
  • Generate hypotheses, stimulate research
  • Evaluate control measures
  • Monitor changes in infectious agents
  • Detect changes in health practices
  • Facilitate planning
poliomyelitis paralytic

60

55

50

1000

45

100

40

10

1

35

0.1

30

0.01

0.001

25

1951

1956

1961

1966

1971

1976

1981

1986

1991

1996

20

15

10

5

0

1968

1973

1978

1983

1988

1993

1998

Poliomyelitis (Paralytic)

United States, 1968-1998

Inactivated Vaccine

Oral Vaccine

Rate/100,000 Population

Reported cases

Year

NOTE: Inactivated vaccine was licensed in 1955. Oral vaccine was licensed in 1961.

Year

Source: CDC. Summary of notifiable diseases. 1998.

uses of public health surveillance16
Uses of Public Health Surveillance
  • Estimate magnitude of the problem
  • Portray the natural history of a disease
  • Determine distribution and spread of illness
  • Detect outbreaks
  • Generate hypotheses, stimulate research
  • Evaluate control measures
  • Monitor changes in infectious agents
  • Detect changes in health practices
  • Facilitate planning
slide17

PPNG

12

TRNG

10

PPNG & TRNG

8

6

4

2

0

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

Trends in Plasmid-Mediated Resistance to Penicillin and Tetracycline

United States, 1988-1997

Source: Gonococcal Isolate Surveillance Project (GISP)

Percent

Year

Note: "PPNG" (penicillinase-producing ) and "TRNG" (tetracycline-resistant) N.gonorrhoeae refer to plasmid-mediated resistance to penicillin and tetracycline, respectively.

uses of public health surveillance18
Uses of Public Health Surveillance
  • Estimate magnitude of the problem
  • Portray the natural history of a disease
  • Determine distribution and spread of illness
  • Detect outbreaks
  • Generate hypotheses, stimulate research
  • Evaluate control measures
  • Monitor changes in infectious agents
  • Detect changes in health practices
  • Facilitate planning
uses of public health surveillance20
Uses of Public Health Surveillance
  • Estimate magnitude of the problem
  • Portray the natural history of a disease
  • Determine distribution and spread of illness
  • Detect outbreaks
  • Generate hypotheses, stimulate research
  • Evaluate control measures
  • Monitor changes in infectious agents
  • Detect changes in health practices
  • Facilitate planning
slide21

20,000

U.S.-born

16,000

Reported cases

12,000

8,000

4,000

Year

0

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

Tuberculosis

United States, 1986-1998

(U.S.- and foreign-born persons)

Foreign-born

Source: CDC. Summary of notifiable diseases. 1998.

uses of public health surveillance22
Uses of Public Health Surveillance
  • Estimate magnitude of the problem
  • Portray the natural history of a disease
  • Determine distribution and spread of illness
  • Detect outbreaks
  • Generate hypotheses, stimulate research
  • Evaluate control and prevention measures
  • Monitor changes in infectious agents
  • Detect changes in health practices
  • Facilitate planning
surveillance for outbreak detection
Surveillance for Outbreak Detection
  • Convergence of technology, volumes of electronic data, and new priority for early detection
  • Increase timeliness and completeness of routine data
  • Capture nontraditional data that signify a condition before a diagnosis is made
  • Analytic methods to detect smaller signals
surveillance for outbreak detection experience
Surveillance for Outbreak Detection: Experience
  • Laboratory specificity to detect clusters
  • Sentinel systems with resources to monitor and investigate
  • Syndrome surveillance where outbreaks are substantial and predictable
  • Case reports trigger outbreak investigation
surveillance for outbreak detection exploration
Surveillance for Outbreak Detection: Exploration
  • Enhanced reporting from clinical sites (ED, EMS, 911, offices)
  • Health care transaction warehouses (pharmacy, patient encounters, lab orders)
  • Novel data sources (retail sales, veterinary encounters, environmental indicators, absenteeism)
  • Signal detection methods
surveillance for outbreak detection reality
Surveillance for Outbreak Detection: Reality
  • Human “technology” is key
    • Single case detection depends on clinical acumen and reporting relationships
    • Epidemiologic judgment in evaluating volumes of data
    • Follow-up of system signals
  • Tolerance for false alarms will vary
surveillance research needs
Surveillance Research Needs
  • Achieving the National Electronic Disease Surveillance System (NEDSS) architecture
  • Data fusion (linkage)
  • New data sources
  • Case definitions (automation/validation)
  • Geographic Information System (GIS) indices
  • Forecasting
  • Evaluation and quality control
resources
Resources
  • www.cdc.gov/cic
  • www.cdc.gov/epo/dphsi/phs.htm
  • www.cdc.gov/epo/dphsi/phs/syndromic.htm
  • dsosin@cdc.gov