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
 Data Sources/Methods
 Notifiable diseases
 Laboratory specimens
 Vital records
 Sentinel surveillance
 Registries
 Surveys
 Administrative data systems
 Other data sources
 Current Status:
National Notifiable Diseases
Surveillance System (NNDSS)
 CSTE/CDC collaboration
 List revised at annual CSTE meeting
 Voluntary reporting by states to CDC
 Reporting mandated at state level
 Reportable diseases vary by state
 National Notifiable Disease
Surveillance
 Reporting mandated by state
law/regulation
 Health care providers, laboratories report to
local HD (county)
 County HD submits reports to State
 Reports transmitted to CDC primarily
through National Electronic
Telecommunications System for
Surveillance (NETSS)
 MUMPS
United States 1973-1998
50 MUMPS — by year, United
Reported Cases per 100,000

45 States, 1983–1998
7

Reported Cases
40 6

per 100,000
Population
35 5
4
Population

30
3
25 2
20 1
0
15
1983 1988 1993 1998
10
Year
5
0
1973 1978 1983 1988 1993 1998
Year
 MEASLES (Rubeola)
United States, 1963-1998
Reported Cases (Thousands)
Vaccine MEASLES — by year, United
500 licensed States, 1983–1998
450

400
30

Reported Cases
25
350

(Thousands)
20 20
300
15
250 10 10
200 5

0
150
1983 1988 1993 1998
100
Year
50

0
1963 1968 1973 1978 1983 1988 1993 1998
Year
Passive vs. Active Surveillance

 Passive
- Provider-initiated

Active


- Health Department-initiated
 Data Sources
 Notifiable diseases
 Laboratory specimens
 Vital records
 Sentinel surveillance
 Registries
 Surveys
 Administrative data systems
 Other data sources
 Salmonellosis
(excluding Typhoid Fever)
30
United States, 1967-1997
Outbreak caused
Reported Cases per 100,000

25 by contaminated
pasteurized milk, IL
20
Population

15

10

0
1967 1972 1977 1982 1987 1992 1997

Year
 Salmonella—serotypes of isolates
United States, 1973-1998 Outbreak caused
30,00 by contaminated
0 Enteritidis
pasteurized milk,
27,00
0 Typhimurium IL
24,00 Unknown
0
Reported isolates

Other
21,00
0
18,00
0
15,00
0
12,00
0
Typhimurium
9,000

6,000
Enteritidis
3,000

0
1973 1978 1983 1988 1993 1998
Year
 Blood Lead Measurements
1975-1981
110 18
Predicted blood lead
100
Lead 16
used in 90 Mean
gasoline blood
80 Gasoline lead
(thousan 14 lead
ds 70 levels
of tons) Observed blood lead  g/dl
12
60

50
10
40

30 8
1975 1976 1977 1978 1979 1980 1981
Year
 Data Sources

 Notifiable diseases
 Laboratory specimens
 Vital records
 Sentinel surveillance
 Registries
 Surveys
 Administrative data systems
 Other data sources
 Use of NCHS Data Systems for
Surveillance
Vital Statistics
 National Infant Mortality Surveillance

(NIMS)
 Linked:

 birth records

 death records
 Data Sources
 Notifiable diseases
 Laboratory specimens
 Vital records
 Sentinel surveillance
 Registries
 Surveys
 Administrative data systems
 Other data sources
 Sentinel Surveillance

 Monitoring of key health events through

sentinel:
 Sites

 Events

 Providers

 Vectors/animals
SENSOR

Sentinel
Event
Notification
System for
Occupational
Risks
 Lead
Poisoning
Michigan,
1990

NONE

1-25

26-100

100+
 Confirmed Work-Related Asthma
Patients
By Industry Type: 1988-1998
Michigan

4%
6%
Manufacturing:
n=960
16% Construction: n=36
Services: n=215
3%
71% Trade: N=47
Miscellaneous: N=76
 Data Sources

 Notifiable diseases
 Laboratory specimens
 Vital records
 Sentinel surveillance
 Registries
 Surveys
 Administrative data systems
 Other data sources
 Lung and Bronchus Cancer (Invasive)
United States, 1973-1994
SEER Incidence and U.S. Mortality
70

60

Incidence
Number/100,000

50

40 Mortality

30

20

10

0
73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94

Year
 Birth Defects Monitoring
Programs
 Vital records
 Hospital discharge summaries
 Hospital records (active abstraction)
 Prevalence of Anencephaly and Spina Bifida
Metropolitan Atlanta Congenital Defects Program,
1968-2000
25
Prenatally Diagnosed Cases
Hospital-based. LB & SB Babies
Rate per 10,000

20

15 Before After
Fortification Fortifcation
10

0
68 71 74 77 80 83 86 89 92 95 98
Year of Birth
 Data Sources
 Notifiable diseases
 Laboratory specimens
 Vital records
 Sentinel surveillance
 Registries
 Surveys
 Administrative data systems
 Other data sources
 Use of NCHS Data Systems for
Surveillance
 Population-based surveys
 National Health Interview Survey
 National Health and Nutrition

Examination Survey
 Provider-based surveys
 National Hospital Discharge Survey
 National Ambulatory Medical Care Survey
 Median Serum Folate, NHANES III and 1999,
Nonpregnant Women, 15-44 years
4.8 14.5
50

40
Post fortification
Percentile

30

20

10
Prefortification
0
0 10 20 30 40
Serum Folate, ng/ml
 Cesarean Deliveries
United States, 1970-1992

30

25
Percentage

20

15
10

5
0
70

74

92
78

80

82
72

86

88
76

84

90
19

19

19
19

19
19
19

19

19

19
19

19

Year
 Data Sources

 Notifiable diseases
 Laboratory specimens
 Vital records
 Sentinel surveillance
 Registries
 Surveys
 Administrative data systems
 Other data sources
 Ectopic Pregnancies
United States 1980-1996

100000

80000

Number of 60000
Ectopic
Pregnancies in 40000
women 15-44 20000

0
82
84

88

92
94
96
80

86

90
Year
 Data Sources

 Notifiable diseases
 Laboratory specimens
 Vital records
 Sentinel surveillance
 Registries
 Surveys
 Administrative data systems
 Other data sources
 Other Data Useful for
Surveillance
 Vaccine Adverse Event Reporting
System
 CDC Drug Service
 Miscellaneous
 Information Loop of Public Health
Surveillance

Public
Reports

Health Care
Summaries,
Providers
Interpretations,
Recommendations
Health
Agencies

Analysis