overview of uses for public health surveillance daniel m. sosin, m.d., m.p.h. division of public...
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Overview of Uses for Public Health Surveillance
Daniel M. Sosin, M.D., M.P.H.Division of Public Health Surveillance and
InformaticsEpidemiology Program Office
Public Health Surveillance
Ongoing, systematic collection, analysis, and interpretation of health-related data and dissemination for use in the planning, implementation, and evaluation of public health practice.
Uses of Public Health Surveillance
Estimate magnitude of the problem Portray the natural history of a disease Determine distribution and spread of
illness Detect outbreaks Generate hypotheses, stimulate research Evaluate control and prevention measures Monitor changes in infectious agents Detect changes in health practices Facilitate planning
Uses of Public Health Surveillance
Estimate magnitude of the problem Portray the natural history of a disease Determine distribution and spread of illness Detect outbreaks Generate hypotheses, stimulate research Evaluate control measures Monitor changes in infectious agents Detect changes in health practices Facilitate planning
Shigellosis1968-1998
00
55
1010
1515
YearYear
1968
1968
1973
1973
1978
1978
1983
1983
1988
1988
1993
1993
1998
1998
Rep
ort
ed
cases p
er
100,0
00
pop
ula
tion
Rep
ort
ed
cases p
er
100,0
00
pop
ula
tion
Source: CDC. Summary of notifiable diseases. 1998.
Uses of Public Health Surveillance
Estimate magnitude of the problem Portray the natural history of a disease Determine distribution and spread of
illness Detect outbreaks Generate hypotheses, stimulate research Evaluate control measures Monitor changes in infectious agents Detect changes in health practices Facilitate planning
TOXIC SHOCK SYNDROME (TSS)United States, 1983-1998
TOXIC SHOCK SYNDROME (TSS)United States, 1983-1998
*Includes cases meeting the CDC definition for confirmed and probable cases for staphylococcal TSS.
1983 1984 1985 1986 1987 1988 19891990 1991 1992 1993 1994 1995 1996 1997 1998
National Center for Infectious Diseases (NCID) data*
National Electronic Telecommunications System for Surveillance (NETSS) data
0
20
40
60
80
100
120
140
160
Year (Quarter)
Rep
ort
ed
cases
Uses of Public Health Surveillance
Estimate magnitude of the problem Portray the natural history of a disease Determine distribution and spread of
illness Detect outbreaks Generate hypotheses, stimulate research Evaluate control measures Monitor changes in infectious agents Detect changes in health practices Facilitate planning
Rate of Hepatitis A United States, 1998
< 5.0< 5.0
5.0–9.95.0–9.9
10.0–19.910.0–19.9 >20.0>20.0
NA
NA
NA
NYCNYC
DCDC
PRPR
VIVI
GUAMGUAM
AM SAMOAAM SAMOA
CNMICNMI
Source: CDC. Summary of notifiable diseases. 1998.
Uses of Public Health Surveillance
Estimate magnitude of the problem Portray the natural history of a disease Determine distribution and spread of
illness Detect outbreaks Generate hypotheses, stimulate research Evaluate control measures Monitor changes in infectious agents Detect changes in health practices Facilitate planning
Botulism (Foodborne) United States, 1978-1998
*Data from survey of state epidemiologists and directors of state public health laboratories. Not yet available for 1998.
*Data from survey of state epidemiologists and directors of state public health laboratories. Not yet available for 1998.
Outbreak caused by potato salad, NM
Outbreak caused by potato salad, NM
Outbreak caused by sautéed onions, IL
Outbreak caused by sautéed onions, IL
Outbreak caused by fermented fish/sea products, AK
Outbreak caused by fermented fish/sea products, AK
Outbreak caused bybaked potatoes, TX
Outbreak caused bybaked potatoes, TX
Laboratory-confirmed cases*Laboratory-confirmed cases*NETSS dataNETSS data
00
1010
2020
3030
4040
5050
6060
7070
8080
9090
100100
110110
YearYear19781978 19831983 19881988 19931993 19981998
Rep
ort
ed
cases
Rep
ort
ed
cases
Source: CDC. Summary of notifiable diseases. 1998.
Uses of Public Health Surveillance
Estimate magnitude of the problem Portray the natural history of a disease Determine distribution and spread of
illness Detect outbreaks Generate hypotheses, stimulate research Evaluate control measures Monitor changes in infectious agents Detect changes in health practices Facilitate planning
YearYear
Rep
ort
ed
cases
(th
ou
san
ds)
Rep
ort
ed
cases
(th
ou
san
ds)
Vaccine licensedVaccine licensed
00
5050
100100
150150
200200
250250
300300
350350
400400
450450
500500
19631963 19681968 19731973 19781978 19831983 19881988 19931993 19981998
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)
Source: CDC. Summary of notifiable diseases. 1998.
MEASLES (Rubeola)United States, 1963-1998
Uses of Public Health Surveillance
Estimate magnitude of the problem Portray the natural history of a disease Determine distribution and spread of
illness Detect outbreaks Generate hypotheses, stimulate research Evaluate control measures Monitor changes in infectious agents Detect changes in health practices Facilitate planning
Poliomyelitis (Paralytic)
NOTE: Inactivated vaccine was licensed in 1955. Oral vaccine was licensed in 1961.NOTE: Inactivated vaccine was licensed in 1955. Oral vaccine was licensed in 1961.YearYear
00
55
1010
1515
2020
2525
3030
3535
4040
4545
5050
5555
6060
19681968 19731973 19781978 19831983 19881988 19931993 19981998
Rep
ort
ed
cases
Source: CDC. Summary of notifiable diseases. 1998.
Rate
/10
0,0
00
Pop
ula
tion
Year
Inactivated Vaccine
Oral Vaccine
0.001
0.01
0.1
1
10
100
1000
1951 1956 1961 1966 1971 1976 1981 1986 1991 1996
United States, 1968-1998
Uses of Public Health Surveillance
Estimate magnitude of the problem Portray the natural history of a disease Determine distribution and spread of
illness Detect outbreaks Generate hypotheses, stimulate research Evaluate control measures Monitor changes in infectious agents Detect changes in health practices Facilitate planning
Trends in Plasmid-Mediated Resistance to Penicillin and
TetracyclineUnited States, 1988-1997
Source: Gonococcal
Isolate Surveillance
Project (GISP)
Perc
en
t
0
2
4
6
8
10
12
1988 1989 1990 1991 1992 1993 1994 1995 1996 1997
PPNGTRNG
PPNG & TRNG
Note: "PPNG" (penicillinase-producing ) and "TRNG" (tetracycline-resistant) N. gonorrhoeae refer to plasmid-mediated resistance to penicillin and tetracycline, respectively.
Year
Uses of Public Health Surveillance
Estimate magnitude of the problem Portray the natural history of a disease Determine distribution and spread of
illness Detect outbreaks Generate hypotheses, stimulate research Evaluate control measures Monitor changes in infectious agents Detect changes in health practices Facilitate planning
Uses of Public Health Surveillance
Estimate magnitude of the problem Portray the natural history of a disease Determine distribution and spread of
illness Detect outbreaks Generate hypotheses, stimulate research Evaluate control measures Monitor changes in infectious agents Detect changes in health practices Facilitate planning
Foreign-born
Source: CDC. Summary of notifiable diseases. 1998.
Year
U.S.-born
1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998
0
4,000
8,000
12,000
16,000
20,000
Rep
ort
ed
cases
Tuberculosis United States, 1986-1998
(U.S.- and foreign-born persons)
Uses of Public Health Surveillance
Estimate magnitude of the problem Portray the natural history of a disease Determine distribution and spread of
illness Detect outbreaks Generate hypotheses, stimulate research Evaluate control and prevention measures Monitor changes in infectious agents Detect changes in health practices Facilitate planning
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
Surveillance for Outbreak 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
Surveillance for Outbreak 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
Surveillance for Outbreak 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
Resources
www.cdc.gov/cic
www.cdc.gov/epo/dphsi/phs.htm
www.cdc.gov/epo/dphsi/phs/syndromic.htm