causal pathway of disease or disability environment (pre-exposure) hazard/agent behavior/risk factor...
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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)
00
55
1010
1515
2020
2525
3030
3535
4040
4545
5050
YearYear
1973
1973
1978
1978
1983
1983
1988
1988
1993
1993
1998
1998
Rep
ort
ed
Cases p
er
100,0
00 P
op
ula
tion
Rep
ort
ed
Cases p
er
100,0
00 P
op
ula
tion
MUMPS — by year, United States, 1983–1998MUMPS — by year, United States, 1983–1998
01234567
YearYear
1983 1988 1993 1998
Rep
ort
ed
C
ases
per
100,0
00
Pop
ula
tion
Rep
ort
ed
C
ases
per
100,0
00
Pop
ula
tion
MUMPSUnited States 1973-1998
YearYear
Rep
ort
ed
Cases
(Th
ou
san
ds)
Rep
ort
ed
Cases
(Th
ou
san
ds)
Vaccine licensedVaccine licensed
00
5050
100
100
150
150
200
200
250
250
300
300
350350
400
400
450
450
500
500
19631963 19681968 19731973 19781978 19831983 19881988 199319931998
1998
MEASLES — by year, United States, 1983–1998MEASLES — by year, United States, 1983–1998
00
55
1010
1515
2020
2525
3030
YearYear
19831983 19881988 19931993 19981998Rep
ort
ed
Cases
(Th
ou
san
ds)
Rep
ort
ed
Cases
(Th
ou
san
ds)
MEASLES (Rubeola)United States, 1963-1998
20
10
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)United States, 1967-1997
Outbreak causedby contaminatedpasteurized milk, IL
1967
1972
1977
1982
1987
1992
1997
5
10
15
20
25
30
0
Rep
ort
ed
Case
s p
er
10
0,0
00
Pop
ula
tion
Year
Salmonella—serotypes of isolates
United States, 1973-1998
YearYear
1973
1973
1978
1978
1983
1983
1988
1988
1993
1993
1998
1998
Enteritidis
Typhimurium
Other
Unknown
Outbreak caused by contaminated pasteurized milk, IL
0
0
3,00
0
3,00
0
6,00
0
6,00
0
9,00
0
9,00
0
12,000
12,000
15,000
15,000
18,000
18,000
21,000
21,000
24,000
24,000
27,000
27,000
30,000
30,000
Rep
ort
ed
iso
late
s
Enteritidis
Typhimurium
Blood Lead Measurements 1975-1981
1975 1976 1977
1978 1979 1980 198130
40
50
60
70
80
90
100
110
8
10
12
14
16
18
Year
Predicted blood lead
Gasoline lead
Observed blood lead
Lead used in gasolin
e(thousa
ndsof tons)
Mean bloodlead
levels g/dl
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 recordsdeath 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 Occupationa
l Risks
Lead Poisonin
gMichigan,
1990
NONE
1-25
26-100
100+
Confirmed Work-Related Asthma Patients
By Industry Type: 1988-1998Michigan
3%
16%
4%
71%
6%Manufacturing: n=960Construction: n=36
Services: n=215
Trade: N=47
Miscellaneous: N=76
Data Sources
Notifiable diseases Laboratory specimens Vital records Sentinel surveillance Registries Surveys Administrative data systems Other data sources
Year
73
74
75
76
77
78
79
80
81 82
83
84
85
86
87
88
89
90
91 92
93
94
Incidence
Mortality
0
10
20
30
40
50
60
70
Nu
mb
er/
10
0,0
00
Lung and Bronchus Cancer (Invasive)
United States, 1973-1994SEER Incidence and U.S. Mortality
Birth Defects Monitoring Programs
Vital records Hospital discharge summaries Hospital records (active abstraction)
0
5
10
15
20
25
68 71 74 77 80 83 86 89 92 95 98
Year of Birth
Ra
te p
er
10
,00
0
Prenatally Diagnosed CasesHospital-based. LB & SB Babies
BeforeFortification
AfterFortifcation
Prevalence of Anencephaly and Spina BifidaMetropolitan Atlanta Congenital Defects Program, 1968-2000
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
0
10
20
30
40
50
0 10 20 30 40
Serum Folate, ng/ml
Per
cen
tile
Median Serum Folate, NHANES III and 1999, Nonpregnant Women, 15-44 years
Post fortification
Prefortification
4.8 14.5
Cesarean Deliveries United States, 1970-1992
0
5
10
15
20
25
30
1970
1972
1974
1976
1978
1980
1982
1984
1986
1988
1990
1992
Year
Perc
en
tag
e
Data Sources
Notifiable diseases Laboratory specimens Vital records Sentinel surveillance Registries Surveys Administrative data systems Other data sources
Ectopic PregnanciesUnited States 1980-1996
0
20000
40000
60000
80000
100000
80 82 84 86 88 90 92 94 96Year
Number of Ectopic
Pregnancies in women 15-44
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
Summaries,Interpretations,Recommendatio
ns
Reports
HealthAgencie
s
Health Care
Providers
Public
Analysis
Information Loop of Public Health Surveillance