Public Health Surveillance Developed through the APTR Initiative to Enhance Prevention and Population Health Education in collaboration with the Brody School of.
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Transcript Public Health Surveillance Developed through the APTR Initiative to Enhance Prevention and Population Health Education in collaboration with the Brody School of.
Public Health Surveillance
Developed through the APTR Initiative to Enhance Prevention and Population
Health Education in collaboration with the Brody School of Medicine at East
Carolina University with funding from the Centers for Disease Control and
Prevention
APTR wishes to acknowledge the following individuals that
developed this module:
Kristina Simeonsson, MD, MSPH
Department of Public Health
Brody School of Medicine at East Carolina University
Julie Daugherty, MPH
Department of Public Health
Brody School of Medicine at East Carolina University
This education module is made possible through the Centers for Disease Control and Prevention (CDC) and the
Association for Prevention Teaching and Research (APTR) Cooperative Agreement, No. 5U50CD300860. The module
represents the opinions of the author(s) and does not necessarily represent the views of the Centers for Disease
Control and Prevention or the Association for Prevention Teaching and Research.
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Define surveillance
Discuss the uses of surveillance
Review notifiable disease surveillance
Describe surveillance limitations
Source: http://www.health.gov/phfunctions/public.htm
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.
www.cdc.gov
Notifiable diseases
Vital records
Environmental monitoring systems
Animal health data
Individuals
Laboratories
Medical records
Over the counter medication sales
Registries
Surveys
population-based
provider-based
Passive
Active
Syndromic
Laboratories, physicians, or others regularly report
cases of disease / death to the local or state health
department
Case reports based on a standard case definition of that
particular disease
Deaths reported on standard certificate
Local or state health departments initiate the
collection of information from laboratories,
physicians, health care providers or the general
population.
Achieves more complete and accurate reporting
More resource intensive for the public health agency
▪ money
▪ personnel
▪ time
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.
Common surveillance syndromes
Gastrointestinal
Influenza-like illness
Rash and Fever
Simple
Timely
Representative
Flexible
Sensitive
Strong predictive value
Acceptable
public
health care providers
Cost-effective
Simple
Timely
Representative
Flexible
Sensitive
Strong predictive value
Acceptable
public
health care providers
Cost effective
Sensitivity
Few if any missed cases
Increase by having broad case definitions
Positive predictive value
Almost all case reports received for illnesses meet the
surveillance case definition
Increase by adopting a more restrictive case definition
Hopkins, R. 2005
Estimate magnitude of the problem
Determine geographic distribution of illness
Portray the natural history of a disease
Detect epidemics / define a problem
Generate hypotheses, stimulate research
Evaluate control measures
Monitor changes in infectious agents
Detect changes in health practices
Facilitate planning
http://www.cdc.gov/osels/ph_surveillance/nndss/phs/overview.htm
Estimate magnitude of the problem
Determine geographic distribution of illness
Portray the natural history of a disease
Detect epidemics / define a problem
Generate hypotheses, stimulate research
Evaluate control measures
Monitor changes in infectious agents
Detect changes in health practices
Facilitate planning
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5853a1.htm
Estimate magnitude of the problem
Determine geographic distribution of illness
Portray the natural history of a disease
Detect epidemics / define a problem
Generate hypotheses, stimulate research
Evaluate control measures
Monitor changes in infectious agents
Detect changes in health practices
Facilitate planning
BOTULISM, Foodborne Outbreak
Reported cases, by year, United States, 1982-2002
Source: CDC. Summary of notifiable diseases. 2002.
Data from the annual survey of State Epidemiologist and Directors of State Public Health Laboratories..
Estimate magnitude of the problem
Determine geographic distribution of illness
Portray the natural history of a disease
Detect epidemics / define a problem
Generate hypotheses, stimulate research
Evaluate control measures
Monitor changes in infectious agents
Detect changes in health practices
Facilitate planning
Varicella (ChickenPox). Number of reported cases --Illinois, Michigan, Texas, and West Virginia*, 1993--2009
www.cdc.gov/mmwr/preview/mmwrhtml/mm5853a1.htm
Foundation is state and local application of the
reportable disease surveillance system known as
National Notifiable Disease Surveillance System
(NNDSS)
Infectious reportable diseases
Noninfectious reportable diseases
▪ Cancer
▪ Elevated blood lead levels
▪ Pesticide-related illness
System for passing reports from the local to state
health departments, and then on to CDC
Role of the Council of State and Territorial Epidemiologists
(CSTE)
List of disease and laboratory findings of public
health interest
Case definitions for their surveillance
Dissemination of surveillance data
Morbidity and Mortality Weekly Report (MMWR)
MMWR Annual Summary of Notifiable Diseases
Uniform criteria for reporting cases
Clinical, Laboratory, Epidemiologic
http://www.cdc.gov/osels/ph_surveillance/nndss/casedef/hepatiti
sacurrent.htm
MMWR Annual Summary of
Notifiable Diseases
http://www.cdc.gov/mmwr/PDF/wk/mm5754.pdf
Reporting by states to the CDC is voluntary
Reporting mandated at state level
state legislation or regulation
Variation in the lists of reportable diseases exists
between states
Resident of long-term care facility hospitalized with
acute hepatitis B
Physician reports case to local health department (LHD)
▪ LHD nurse remembers several other cases of acute
hepatitis B at same facility in past year
▪ Unsuspected outbreak of acute hepatitis B was
discovered in the facility
MMWR, March 11, 2005 / 54(09);220-223
Stillborn infant delivered at hospital diagnosed with
listeriosis
Physician reports case to LHD
▪ Outbreak of listeriosis was identified among
Hispanic females with 12 cases identified over 4 month
period
5 stillbirths
3 premature births
2 infected newborns
▪ Case-control study identified common source of exposure
MMWR, July 06, 2001 / 50(26);560-2
Used with permission from Robert E. Whitwam
Incomplete data
Overwhelming volumes of data from a variety of
sources make management complex
Uneven application of information technology
Paper versus electronic reporting
Timeliness
Reporting time requirement
Reporting burden
Completeness
Unreported cases
Incomplete reports
CDC’s Burden of Illness Pyramid: Underascertainment of
Foodborne Illness in Notifiable Diseases Surveillance
Source: Adapted from Centers for Disease Control and Prevention, “FoodNet Surveillance - Burden of Illness
Pyramid.” http://www.cdc.gov/foodnet/surveillance_pages/burden_pyramid.htm. Accessed October 3, 2011.
100 persons infected with shigella
76 symptomatic
28 consulted a healthcare provider
9 submitted stool cultures
7 had positive results
6 reported to the local health department
5 reported nationally to CDC
Rosenberg et al, 1977
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Lack of awareness of legal requirement
Lack if knowledge of which conditions are
reportable
Lack of knowledge of how or to whom to report
Assumption that someone else will report the case
Intentional failure to report to protect patient
privacy
Insufficient reward for reporting
Insufficient penalty for not reporting
Doyle et al, 2002
Costly
Staff expertise required
Formal evaluations of syndromic surveillance
systems are incomplete
Inadequate specificity = false alarms
Software recognizes key words
Uses resources in investigation
Inadequate sensitivity = failure to detect outbreaks
or bioterrorism events
Outbreak is too small
Population disperses after exposure, cluster not evident
Surveillance data has many practical uses
Notifiable disease surveillance is fundamental to
prevention and control efforts
List of notifiable diseases varies by state
Significant improvements are being made in
advancing surveillance and reporting
Center for Public Health Continuing Education
University at Albany School of Public Health
Department of Community & Family Medicine
Duke University School of Medicine
Mike Barry, CAE
Lorrie Basnight, MD
Nancy Bennett, MD, MS
Ruth Gaare Bernheim, JD, MPH
Amber Berrian, MPH
James Cawley, MPH, PA-C
Jack Dillenberg, DDS, MPH
Kristine Gebbie, RN, DrPH
Asim Jani, MD, MPH, FACP
Denise Koo, MD, MPH
Suzanne Lazorick, MD, MPH
Rika Maeshiro, MD, MPH
Dan Mareck, MD
Steve McCurdy, MD, MPH
Susan M. Meyer, PhD
Sallie Rixey, MD, MEd
Nawraz Shawir, MBBS
Sharon Hull, MD, MPH
President
Allison L. Lewis
Executive Director
O. Kent Nordvig, MEd
Project Representative