Surveillance Fixx

Place photo here
Surveillance
What You Will Learn
By the end of this unit you should be able
to:
describe the components of a surveillance system
define sentinel surveillance, laboratory-based surveillance and
case definitions
define incidence and prevalence
Define public health surveillance and its main components

(activities)
List the main uses of surveillance data
Describe sources for data that can be used for public health
surveillance
Describe the flow of information for reportable diseases
#1-4-3
What is Surveillance?
Systematic collection of information on a
specific disease or other health-related
event
Must occur on an ongoing basis with

sufficient accuracy and completeness for
data analysis
Utilisation of information for disease

prevention and control
# 1-4-4
Public Health Surveillance
Ongoing, systematic collection,
analysis, and interpretation of
health-related data essential to the
planning, implementation, and
evaluation of public health practice,
closely integrated with the timely
dissemination of these data to those
responsible for prevention and
control.
Public Health Surveillance
Systematic, on going
Collection
Analysis
Interpretation
Dissemination
Link to public health practice
What is surveillance?
Continuous observation of the factors that
determine the occurrence and distribution
of disease and other conditions of ill-health
Steps in surveillance:
Information Loops
A surveillance system is an
information loop or cycle that
involves:
healthcare providers
public health agencies
the public
# 1-4-5
Figure 4.1. Flow of
Surveillance Data
Collection
Dissemination,
Assessment
Utilisation
Analysis and
Interpretation
# 1-4-6
Implementation:
How do you
do it?
Public Health Intervention
Approach Evaluation:
What
works?
Risk Factor
Identification:
What is the
cause?
Surveillance:
What
is the
problem?
Problem Respons
e
Purposes of Public Health Surveillance
Assess public health status
Define public health priorities
Evaluate programs
Stimulate research
Essential activities of surveillance
1. Identify; define and measure the health problem of interest;
2. Collect and compile data about the problem (and if possible,
factors that influence it)
3. Analyze and interpret these data
4. Provide these data and their interpretation to those
responsible for controlling the health problem and
5. Monitor and periodically evaluate the usefulness and quality
of surveillance to improve it for future use.
N.B
surveillance of a problem does not include actions to control
the problem.
Surveillance is
Information for Action
Information Loop of Public Health
Surveillance
(involving health care providers, public health
agencies, and the public)
Public
Report
s
Health
Summaries,
Care
Interpretations,
Providers
Recommendatio
ns Health
Agencie
s
Analysis
The components of surveillance and resulting
public health action
Surveillance System Components
Population of interest
Public health response
which generates events
Interpretation for associations,

Measurement
trends, unusual patterns, signals
and recording
Analytical applications
Transactional data
Data Management Data preprocessing for a

Quality checks specific purpose
8/4/1428 Editing Dr. Salwa Tayel
(views, data marts) 16
Purposes of Public Health Surveillance
Public health surveillance provides and interprets
data to facilitate the prevention and control of
disease.
Surveillance Terms
Universal case reporting a surveillance system
in which all cases of a disease are supposed
(diharapkan) to be reported
Sentinel surveillance a surveillance system in

which reports are obtained from certain facilities or
populations
Laboratory-based reporting a surveillance

system in which the reports of cases come from
clinical laboratories instead of healthcare
practitioners or hospitals
# 1-4-7
Types of surveillance
Depending on the method of data collection
Active surveillance there is an active

search for cases eg: house to house surveys.
Passive surveillance data collection by

public health agencies from the patients
who come to them. eg: national notifiable
disease surveillance system
Sentinel surveillance can be active or

passive.
Terms Related to
Surveillance, Cont.
Passive surveillance a system in
which data generated without
solicitation (meminta), intervention
or contact by the health agency
carrying out the surveillance. Other
agencies initiate reporting.
Active surveillance the

organization conducting surveillance
initiates procedures to obtain reports
# 1-4-9
Types of Surveillance
1. Passive (Routine reporting system)
Hospitals, health centers, health facilities.
Reporting is governed by existing local rules.
Advantages:
Inexpensive.
Standardized.
Good for monitoring large numbers of typical health
events
Disadvantages:
Under-reporting is a problem
Incomplete data
Busy doctors & nurses
8/4/1428 Dr. Salwa Tayel 21
Types of Surveillance
2-Active (Sentinel reporting system):
Collection of data on a specific disease for a relatively limited period
of time.
By selected health units, certain physicians,
Advantages:
More consistent pictures.
Motivated.
Disadvantages:
Not representative
Active surveillance is relatively expensive practice.
It is usually limited to disease elimination programs and to short-
term intensive investigation and control activities, or to seasonal
problems, (e.g. Influenza, arboviruses).
22
Terms Related to
Surveillance, Cont.
Case definition the clinical and laboratory
characteristics that a patient must have to be
counted as a case for surveillance purposes
Prevalence the proportion of persons in a

population who have a disease or condition at a
given point in time
Incidence the number of persons who newly

develop a disease or condition within a specified
period of time
# 1-4-8
Table 4.1. Relationship
Between Disease and Case
Definition True Disease
Case Definition Present Absent Total
Met a b a+b
Not Met c d c+d
Total a+c b+d N
# 1-4-10
Additional Surveillance
Terms
Sensitivity the ability of a case

definition or laboratory test to predict
true disease (a/(a+c))
Specificity the ability of a case

definition or laboratory test to predict
absence of true disease (d/(b+d))
# 1-4-11
Additional Surveillance
Terms, Cont.
Positive predictive value proportion
of persons meeting a case definition,
having a positive test, that have true
disease (a/(a+b))
Negative predictive value proportion

of persons not meeting a case definition,
having a negative test, that do not have
true disease (d/(c+d))
# 1-4-12
Uses of Public Health Surveillance
Estimate magnitude (ukuran) of the problem
Determine geographic distribution of illness
Describe the natural history of a disease
Detect epidemics/define a problem
Generate hypotheses, stimulate research
Evaluate programs, control measures
Monitor changes in infectious agents
Detect changes in health practices & services
Assess and monitor public health problems
Useful in setting priorities to facilitate
planning
Estimate magnitude of the problem
Portray the natural history of a disease
Evaluate control measures
Detect changes in health practices
Facilitate planning
SHIGELLOSIS
Reported cases per 100,000 population, by year,
United States, 1972-2002
Source: CDC. Summary of notifiable diseases. 2002


Facilitate planning
HEPATITIS A
Reported cases per 100,000 population,
United States and U.S. territories, 2002

Uses of Public Health
Surveillance

Describe the natural history of a disease
Facilitate planning
TOXIC-SHOCK SYNDROME
Reported cases, by quarter,

Surveillance
Facilitate planning
BOTULISM, FOODBORNE
Reported cases, by year,
Data from the annual survey of State Epidemiologist and Directors of State Public Health Laboratories. . Source: CDC. Summary of notifiable diseases. 2002
Surveillance
Facilitate planning
MEASLES
Reported cases, by year,

PERTUSSIS
Reported cases*, by age group,
United States, 2002
*Of 9,771 cases, 25 were reported with unknown age.

Surveillance
Facilitate planning
POLIOMYELITIS, PARALYTIC, VACCINE ASSOCIATED
Reported cases by year,

Surveillance
Facilitate planning
Trends in Plasmid-Mediated Resistance to Penicillin and
Tetracycline
12
Percent PPNG
10 TRNG
PPNG & TRNG

8
6 Source: Gonococcal
Isolate Surveillance
Project (GISP)
4
0
1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 Year
Note: "PPNG" (penicillinase-producing ) and "TRNG" (tetracycline-resistant) N. gonorrhoeae refer to plasmid-mediated
resistance to penicillin and tetracycline, respectively.
Surveillance
Facilitate planning
Breast Cancer Screening
Surveillance
Facilitate planning
TUBERCULOSIS
Reported cases among U.S.-born and foreign-born
persons*, by year, United States, 1990-2002
*In 2002, place of birth was unknown for 120 case-patients.

Obesit
United States,y
1987-
1998
Physical Activity
Georgia 1998
Source: BRFSS 1998

Past Approaches
Duplication of efforts and resources
Delays in reporting and identification of

outbreaks
Lack of dissemination and feedback to the local

level
Lack of integration of training and surveillance

activities
# 1-4-13
Common Problems with Past
Surveillance Systems, Cont.
Limited evaluation of programmes
Inadequate involvement of
laboratories
Incomplete reporting and lack of

supervisory support
# 1-4-14
Integrated Disease Surveillance (IDS)
Integrates priority communicable disease

surveillance activities at the district level
Provides support for training and supervision
Full-time district-level staff dedicated to

monitoring health events in the community
mobilising community action
encouraging national assistance
accessing regional resources
Resources combined to collect information at each

level
# 1-4-15
IDS Goals
Strengthen the capacity of countries to conduct
effective surveillance activities
Integrate multiple surveillance systems so that forms,

personnel and resources can be used more efficiently
and effectively
Improve the use of information for making decisions
Improve the flow of surveillance information between

and within levels of the health system
# 1-4-16
IDS Goals, Cont.
Improve laboratory capacity in identification of
pathogens and monitoring of drug sensitivity
Increase the involvement of clinicians in the

surveillance system
Emphasise community participation in detection

of and response to public health problems
Strengthen the involvement of laboratory

personnel in epidemiologic surveillance
# 1-4-17
Examples of Priority
Communicable Diseases for
IDS
Epidemic-prone diseases
Cholera
Yellow fever
Diseases targeted for eradication and
elimination
Polio
Neonatal tetanus
Other diseases of public health importance

Malaria
# 1-4-18
Identifying Health
Problems for
Surveillance
Selecting a Health Problem for
Surveillance:
Conducting surveillance for a health
problem consumes time and resources.
It is important to select and prioritizing
health problems for surveillance
55
Criteria for selecting and
prioritizing health problems for
surveillance:
Public health importance of the problem:
incidence, prevalence,
severity, sequela, disabilities,
mortality caused by the problem,
socioeconomic impact,
communicability,
potential for an outbreak,
public perception and concern, and
international requirements.
Criteria for selecting and prioritizing
health problems for surveillance:
Ability to prevent, control, or treat the health
problem:
preventability and
Availability of control measures and treatment.
Capacity of health system to implement control

measures for the health problem:
Immediate response
availability of resources
Sources and Methods for
Gathering Data
Three main sources:
Individual Persons
Health-care providers, facilities, and records
Physician offices
Hospitals
Outpatient departments
Emergency departments
Inpatient settings
Laboratories
3. Environmental conditions
Air
Water
Animal vectors

Methods used to collect
the health-related data
1. Environmental monitoring
2. Surveys
3. Notifications
4. Registries.

Surveys
Surveys, uses a structured and systematic
gathering of information from a sample of a
population of interest to describe the
population in quantitative terms.

Notification
A notification is the reporting of
certain diseases or other health-
related conditions by a specific group,
as specified by law, regulation, or
agreement.
Notifications are typically made to the
state or local health agency.

Registries
Reregistery is a method for documenting or
tracking events or persons over time.
Examples:
Registries of vital events (birth and death
certificates) are required by law and contain
important health-related information.
A disease registry (e.g., a cancer registry) tracks
a person with disease over time and usually
includes diagnostic, treatment, and outcome
information.

Surveillance data usually
collected are:
Vital events, births, deaths, marriages,
divorce,...
Morbidity data; infections diseases, non-

communicable diseases, birth defects,
injuries,...
Mortality data
Analyzing and Interpreting
Data
Analyzing by time
Analyzing by place
Analyzing by person
Interpreting results of analyses
Observed increases or decreases in disease

incidence or prevalence might be an
artifact.
Common causes of artifactual (not true)
change in disease occurrence are:
Changes in local reporting procedures or policies (e.g., a change
from passive to active surveillance).
Changes in case definition (e.g., AIDS in 1993).
Increased health-seeking behavior (e.g., media publicity
prompts persons with symptoms to seek medical care).
Increase in diagnosis.
New laboratory test or diagnostic procedure.
Increased physician awareness of the condition, or a new
physician is in town.
Increase in reporting (i.e., improved awareness of reporting).
Outbreak of similar disease, misdiagnosed as disease of interest.
Laboratory error.
Disseminating Data and
Interpretations
Data and interpretations should be sent to:
those who provided reports or other data (e.g., health-care
providers and laboratory directors).
They should also be sent to those who use them for
planning or
managing control programs,
Administrative purposes,
or other health-related decision-making.
Causal Pathway of Disease or
Disability
Environment (pre-exposure)
Hazard/agent
Behavior/risk factor
Exposure
Pre-symptomatic phase
Apparent disease
Death
Selected Sources of Data
Environmental monitoring
systems
Animals/vectors
Individuals
Laboratories
Medical records
Administrative records
Police records
Birth/death certificates
Data Sources and Methods for
Surveillance
Notifiable diseases
Laboratory specimens
Vital records
Sentinel surveillance
Registries
Surveys
Administrative data systems
Other data sources
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
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
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
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
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
In Summary
Surveillance is the collection of data relevant to
public health, which can then be analysed to
guide prevention and treatment programmes.
Sentinel surveillance involves the collection of

more detailed data from a smaller sample of sites
Laboratory-based reporting occurs when case

reports come from laboratories instead of health
facilities.
# 1-4-19
In Summary, Cont.
Prevalence is the proportion or number

of persons in a certain population who
have a particular disease.
Incidence measures new infections

during a specific time period.
# 1-4-20
Resources
www.cdc.gov/cic
www.cdc.gov/epo/dphsi/phs.htm
www.cdc.gov/epo/dphsi/phs/syndromic.htm
dsosin@cdc.gov

Surveillance Fixx

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Surveillance Fixx

Uploaded by

Copyright:

Available Formats

Place photo here

Define public health surveillance and its main components

Must occur on an ongoing basis with

Utilisation of information for disease

public health agencies

Interpretation for associations,

Data Management Data preprocessing for a

Sentinel surveillance a surveillance system in

Laboratory-based reporting a surveillance

Active surveillance there is an active

Passive surveillance data collection by

Sentinel surveillance can be active or

Active surveillance the

Prevalence the proportion of persons in a

Incidence the number of persons who newly

Case Definition Present Absent Total

Not Met c d c+d

Total a+c b+d N

Sensitivity the ability of a case

Specificity the ability of a case

Negative predictive value proportion

Source: CDC. Summary of notifiable diseases. 2002

Estimate magnitude of the problem

Source: CDC. Summary of notifiable diseases. 2002

Estimate magnitude of the problem

Source: CDC. Summary of notifiable diseases. 2002

Source: CDC. Summary of notifiable diseases. 2002

*Of 9,771 cases, 25 were reported with unknown age.

Source: CDC. Summary of notifiable diseases. 2002

Source: CDC. Summary of notifiable diseases. 2002

PPNG & TRNG

*In 2002, place of birth was unknown for 120 case-patients.

Source: BRFSS 1998

Delays in reporting and identification of

Lack of dissemination and feedback to the local

Lack of integration of training and surveillance

Incomplete reporting and lack of

Integrates priority communicable disease

Provides support for training and supervision

Full-time district-level staff dedicated to

Resources combined to collect information at each

Integrate multiple surveillance systems so that forms,

Improve the use of information for making decisions

Improve the flow of surveillance information between

Increase the involvement of clinicians in the

Emphasise community participation in detection

Strengthen the involvement of laboratory

Other diseases of public health importance

Capacity of health system to implement control

8/4/1428 Dr. Salwa Tayel 58

8/4/1428 Dr. Salwa Tayel 59

8/4/1428 Dr. Salwa Tayel 60

8/4/1428 Dr. Salwa Tayel 61

8/4/1428 Dr. Salwa Tayel 62

Morbidity data; infections diseases, non-

Observed increases or decreases in disease

Achieving the National Electronic Disease

Sentinel surveillance involves the collection of

Laboratory-based reporting occurs when case

Prevalence is the proportion or number

Incidence measures new infections

You might also like