DPR Korea

Training on Epidemiology and Use of Epidemiological Software, DPR Korea, Nov 12 - Dec9, 2005

WHO/CSR

Principles of Disease Surveillance

WHO/CSR

Surveillance
Surveillance is the ongoing systematic collection, collation, analysis and interpretation of data; and the dissemination of information to those who need to know in order that action may be taken
WHO/CSR

Rationale for Disease Surveillance
• The disease is of public health importance • Caution!
– Is it worth the effort (money, human resources)? – Are relevant data easily available? – Can action be taken?

WHO/CSR

Objectives of surveillance
• Monitoring trends and estimate magnitude of health problem • Epidemic (outbreak) detection and prediction • Monitor progress towards a control objective • Monitor programme performance • Estimate future disease impact • Evaluating an intervention • Understand characteristics of health events • Distribution and spread • Natural history • Facilitate planning
WHO/CSR

Objective: To monitor the trend of laboratory confirmed malaria and proportion due to P. falciparum

Cases of malaria in a region, 1992-1996
600 500 400 300 200 100 0 1992 1993 1994 1995 1996
WHO/CSR

Others Faciparum

Objective:

To detect outbreaks of dysentery by monitoring number of blood diarrhoea cases

Cases of acute bloody diarrhoea in a rural district by month, January 1994- April 1995
120 100 80 60 40 20 0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr

Cases

1994

1995
WHO/CSR

Objective: To monitor progress towards polio eradication by monitoring the incidence of poliomyelitis where wild poliovirus is isolated in children under 14 years
Cases of poliomyelitis where wild poliovirus was isolated in children in a rural district, 1980-1996
250 200 150 100 50 0 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 NID NID Cases

Objective: To monitor the ability of a TB programme to ensure treatment completion and cure
Treatment completion and cure in TB cases, 1994-1997
1600 1400 1200 1000 800 600 400 200 0 1994 1995 1996 1997
WHO/CSR

Cases Completion Cure

Objective:

To predict future trends of AIDS for health service planning

Cases of AIDS in a city district, 1990-2004
700 600 500 400 300 200 100 0 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04

Steps in planning a surveillance system
• • • • • • • • • Establish objectives Develop case definition Determine data source or data collection mechanism Develop data collection instrument Field-test methods Develop and test analytic mechanism Develop dissemination mechanism Assure use of analysis and interpretation Evaluation

WHO/CSR

Case definition
• Clinical versus laboratory • Level of case definition (suspected, probable, confirmed) • Example Influenza:
– Suspected: A person with sudden onset of fever > 39C, respiratory symptoms, myalgias, headaches – Probable: A suspected case , epidemiologically linked to labortory-confirmed case – Confirmed: A suspected case with virus isolation or direct antigen detection

WHO/CSR

Data source and data collection mechanism
• Data source
– – – – – – notifiable diseases vital statistics survey laboratory member of the public, media other information sources, e.g. sanitarian data, metereological data, immunisation, nutrition

• Data collection
– passive vs active
WHO/CSR

Dissemination mechanism
• • • • Directly to all who need to know Press release to the public Reports, bulletins Others

WHO/CSR

Assure use of analysis and interpretation
• Control measures
– rapid response – case management – prevention programme (immunisation)

• Planning/ policy making
– epidemic preparedness – policy modification – prediction and future planning

• Feedback to the system
WHO/CSR

Surveillance: Tasks
Peripheral level Detect Treat Report Analyse Investigate Report Respond Feedback Analyse Investigate Confirm Respond Plan and Fund Feedback Analysis and feedback Support Policy and targets Funding

Intermediate level

Central level

Ministry of Health

Regional/International level WHO

Surveillance: General Principle
Health Care System Reporting Data Information Public Health Authority

Evaluation

Analysis & Interpretation

Feedback Action Decision

WHO/CSR

Surveillance functions
Core function
• • • • • Reporting Detection Investigation & confirmation Analysis & interpretation Action / response

Support function
• • • • Training Supervision Resources Standards / guidelines
WHO/CSR

Surveillance: Basic Ingredients
A good network of motivated people Clear case definition and reporting mechanism Efficient communication system Basic but sound epidemiology Laboratory support Good feedback and rapid response
WHO/CSR

Report
Lab. confirmation

Clinical case Seek medical attention Disease Infected Exposed
WHO/CSR

What is the difference between recording/reporting and surveillance

WHO/CSR

Disease notification is not the only method in surveillance system!!!

WHO/CSR

Venice: L. Thaikruea

Venice: L. Thaikruea

Krop khun Krap

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