surveillance and notification of diseases
TRANSCRIPT
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SURVEILLANCE AND NOTIFICATION OF
DISEASESGhaiath M.A. HusseinMBBS, MHSc. (Bioethics)
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Outline of presentation
• What is surveillance?• What are the objectives of surveillance?• How to establish/run an effective surveillance
system?• Challenges to effective surveillance• Key messages
GhaiathSurveillance (JPFCM, Jan. 2010)
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What is an epidemiological surveillance system?
• The systematic collection, analysis, interpretation, and dissemination of health data on an ongoing basis, to gain knowledge of the pattern of disease occurrence and potential in a community, in order to control and prevent disease in the community.
• Epidemiological surveillance is a process of watchfulness over health events which may occur in a population.
• A set of interconnected elements and activities that are usually established as an integral part of a health care system in order to monitor priority health events.
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Surveillance: General principle
Health Care System Public Health Authority
Data Information
DecisionAction
Feedback
Reporting
EvaluationAnalysis & Interpretation
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“Public Health Surveillance”
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• Describes the scope (surveillance)
• Indicates the context in which the event occurs (public health)
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Task oriented approach to Communicable Disease Surveillance and Control
P P P P P P
II
C
World Health OrganisationRegional Offices + HQ
P = peripheral levelI = intermediate levelC = central Level
Detect TreatReport
AnalyseInvestigateReportRespondFeedback
Analysis and feedback SupportPolicy and targetsFunding
AnalyseInvestigateConfirmRespondPlan and FundFeedback
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Elements of Surveillance
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• Collection
• Analysis
• Interpretation
• Dissemination
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Components of Public Health Practice
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• Surveillance
• Research: epidemiological, behavioral, and laboratory
• Service (program evaluation)
• Training
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Purposes of Public Health Surveillance Data
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• Assess status• Define position• Monitor and evaluate programs• Conduct research• Identify problems
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Comparing the number of confirmed dengue fever cases by International weeks
2006-2009
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Confirmed dengue fever cases up to 31st International week2006-2009
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• األولى (32000المرحلة - صفر ) محرم منزل• الثانية (130000المرحلة تاريخه ) حتى األول ربيع منزل
GhaiathSurveillance (JPFCM, Jan. 2010)
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Steps in Planning Surveillance
1. Establish objectives2. Develop case definitions3. Develop data collection system4. Develop data collection instruments5. Field test methods
6. Develop data analysis approach
7. Determine dissemination mechanism
8. Determine evaluation method
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Which condition to surveillance?Page 14 of
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Criteria for Determining High-Priority Events• Frequency
• Severity
• Direct and indirect costs
• Preventability
• Communicability• Public interest• Emerging issues
• Consensus process
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Elements of a Case DefinitionPage 15 of
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• Criteria for time, place, and person
• Clinical and laboratory diagnosis
• Epidemiological features of disease
• Degree of certainty regarding diagnosis
• High sensitivity and specificity
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Data Collection
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Determining Data Collection Systems
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• Methods of data collection
• Balance between system and its purpose
• Timeliness
• Type of condition
• Need for lab-based information
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Types of Data Collection Systems
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• Vital records system
• Existing data sets
• Existing registries or surveys
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Passive SystemsPage 19 of
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• Simple
• Less burdensome
• Limited by variability
• May not be representative
• May fail to identify outbreaks• Portray trends
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Active SystemsPage 20 of
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• Validate representativeness
• Assure more complete reporting
• Can be used with specific investigations
• Can be used for brief periods
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Uses of Limited Surveillance Systems
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• Resolve specific problems
• Identify all cases
• Use for logistic or economic reasons
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Sentinel Surveillance
• Encompasses a wide range of activities focused on monitoring key health indicators in general or in special populations
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Sentinel refers to
• Key health events
• Clinics or other sites at which health events are monitored
• Reporters who report specific health events
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Sentinel Sites
• Hospitals
• Clinics
• Counties
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Role of Sentinel Sites
• Monitor conditions for which information is not otherwise available
• Monitor conditions in subgroups which are more vulnerable than general population
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Analysis and Interpretation of surveillance data
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Considerations in Analysis of Surveillance Data
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• Know inherent idiosyncrasies of data set
• Proceed from simplest to most complex
• Realize when inaccuracies in data preclude more sophisticated analyses
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Key Concepts that Determine Accuracy of Surveillance Data
Reliability:Is a particular condition reported consistently by different observers?
Validity:Does the particular condition as reported reflect the true condition as it occurs?
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Basic Epidemiological Parameters
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• Time
• Place
• Person
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Data Analysis by Time
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• Compare number of case reports received during a specific interval
• Compare number of cases for a current time period with number reported during same interval during previous time period
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Data Analysis by Place
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• Where exposure occurred, not where it’s reported from
• Allows prevention resources to be targeted effectively
• Use of computers and spatial mapping software allows for sophisticated analysis
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Data Analysis by Person
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Possible variables:agegenderrace or ethnicitymarital statusoccupationlevels of income and education
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Interactions Among Time, Place, and Person
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• Interactions can obscure patterns of disease and injury
• Syphilis in the 1980s
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Why Interpret and Disseminate Information?
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• Help decision makers understand the implications of information
• Facilitate consequent implementation of public health action
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Interpretation of InformationPage 40 of
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• Present information clearly
• Know your audience
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Considerations for Dissemination
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• Balance access with privacy constraints
• Provide analyses and recommendations
• Use clear and concise materials
• Use communications media
• Use current AV technology
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Steps in Dissemination
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1. Use visual displays to convey structure of data and analyses
2. Transform data mathematically to simplify distribution
3. Investigate influence of outliers
4. Examine residuals
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Purpose of Graphics
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• To visually display measured quantities• To allow researchers to mesh presentation and
analysis• To organize, summarize, and display
information clearly and effectively
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Tables
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• Arrange data in rows and columns• Demonstrate data patterns and relationships
among variables• Serve as a source of information for other
types of data graphics
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Guidelines for Developing a Table
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• Describe what, when, where in the title• Label rows and columns clearly• Provide units of measure• Provide row and column totals• Define abbreviations and symbols• Note data exclusions• References Source• Should stand alone
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البعوضوالعدد ليرقات المستكشفة المواقع بعدد بياناإليجابي
وفبراير يناير شهري خالل المكرمة م2009بمكة
اليرقات األخرى
األيدس يرقات عددإيجبتاي ألماكن ا
اإليجابية لليرقــــات
المواقـــــع
المستكشفة
األسبوع الوبائي
الشهـــــــط1طر
2ط1ط
2 4ط + 3ط 2ط + 1ط
357 254 547 110 25 770 1
يناير
567 133 421 87 43 926 2
510 168 296 193 45 841 3
216 95 530 264 40 819 4
302 110 610 329 54 956 5
145 24 608 128 55 884 6
فبراير646 312 599 305 13 1038 7
331 231 456 163 83 876 8
275 151 328 204 57 1118 9
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Graphs
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• Visually display quantitative information• Provide system of coordinates• Assist reader to visualize patterns and
trends
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Guidelines in Developing Graphs
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• Label title, source, axes, scales, legend• Minimize the number of coordinate lines• Portray frequency on the vertical scale, starting
with zero• Portray method of classification on the horizontal
scale• Indicate units of measure• Define abbreviations and symbols• Note data exclusions
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Maps
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• Graphically represent data using location and geographic coordinates
• Provide a clear, concise, and quick method for grasping data
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• األولى (32000المرحلة - صفر ) محرم منزل• الثانية (130000المرحلة تاريخه ) حتى األول ربيع منزل
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Limitations in Data
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• Under-reporting
• Unrepresentativeness
• Inconsistent case definitions
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Considerations for Interpreting
Data
• Has nature of reporting changed?
• Have new providers or geographic areas entered the system?
• Has case definition changed?
• Has new intervention been introduced?
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Interpretive Uses for Surveillance Data
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• Monitoring trends • Identifying epidemics• Identifying syndrome• Evaluating public policy• Projecting future needs
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Limitations of Reporting Systems
• Under reporting• Incomplete reporting
* If consistent surveillance methods are used, data will describe trends despite under reporting
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Factors Contributing to Incomplete Reporting
• Concealment due to social stigma• Lack of awareness of requirements• Inadequate knowledge of case definitions• Changes in procedures• Variations in diagnosis skills• Low priority
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Strengths of Reporting System
• Quick information• Detect changes in patterns• Detection of outbreaks• Availability of information from all
jurisdictions• Basis for prevention recommendations
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Discussion… (Qs & As)
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references
• FETP series lectures on epidemiology
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