Transcript Surveillance - Community Commons

Introduction to Public Health
Surveillance
July 26,
2010
Public Health Surveillance
Ongoing, systematic collection, analysis, and
interpretation of health-related data
essential to the planning, implementation, and
evaluation of public health practice,
closely integrated with the timely dissemination of
these data to those responsible for prevention
and control.
Centers for Disease Control and Prevention (CDC)
Surveillance as a Tool for Community
Protection
 Initially used for disease control
 Now used for:
 Communicable and infectious disease
 Chronic disease
 Injury
 Occupational hazards
 Other conditions and behaviors
Objectives of Public Health Surveillance
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Estimate magnitude of the problem
Document distribution and spread of health event
Understand the natural history of a disease
Detect outbreaks or epidemics
Test hypotheses about origin of disease
Evaluate control strategies
Monitor changes in infectious agents
Monitor isolation activities
Detect changes in health practice
Assess the quality of health care
Assess safety of drugs and procedures
Identify research needs and facilitate research
Facilitate planning
Principles and Practice of Public Health Surveillance, Teutsch, SM, Churchill, RE. 2000 Oxford University Press.
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Types of Surveillance
 Passive
 Active
 Syndromic
Passive Surveillance
 Provider initiated
Laboratories, physicians, or other health care
providers regularly report cases of disease to the local
or state health department based on a standard case
definition of that particular disease.
Active Surveillance
 Health agency initiated
Local or state health departments initiate the
collection of specific cases of disease from
laboratories, physicians, or other health care providers.
Active Surveillance Applications
 Outbreak investigations
 Contact hospitals and practitioners
 Use media to locate cases
 Other times when complete case ascertainment is
desired (e.g., research study)
Syndromic Surveillance
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.
Indicators
 Clinical signs
categorized into
syndromes
 Not a specific diagnosis
Example:
Cough + Sore throat +
Fatigue + Fever =
Influenza-Like Illness (ILI)
Purposes of surveillance at state
and local level
1.
Trigger disease control activities
a) Accurate diagnosis and treatment
b) Management of persons exposed to disease
c) Identify disease outbreaks
d) Recognize an unusual event
2. Plan, implement, and evaluate health promotion and
disease prevention programs
Notifiable Disease Surveillance System
 Department of Health Services (DHS), Division of Public
Health (DPH)
 Wisconsin Electronic Disease Surveillance System (WEDSS)
facilitates reporting, investigation, and surveillance
 Report de-identified, case-level data to Centers for Disease
Control and Prevention (CDC) weekly
 National Notifiable Disease Surveillance System (NNDSS), CDC
 60 nationally notifiable infectious diseases
 List developed and revised by Council of State and Territorial
Epidemiologists (CSTE) and CDC
 CDC publishes national data in MMWR (Morbidity &
Mortality Weekly Report)
Legal authority for disease surveillance
 Chapter 252 Communicable diseases
 Defines powers and duties of Department of Health
Services and local health officers
 Requires reporting of communicable disease cases and
authorizes isolation and quarantine
 Authorizes communicable disease prevention and
control programs
Communicable
Disease Reporting
 Licensed healthcare
Who Needs to
Report?
 Labs
personnel
 Health care facilities
 Teachers, principals, or
nurses in a school or day care
center
 Any person who knows or
suspects a person has a
communicable disease
Category I Reportable Diseases
 Urgent public health importance
 Reported immediately by phone, followed by
entering into WEDSS (or 4151)
 Includes vaccine preventable diseases,
bioterrorism agents, food & waterborne
outbreaks
 Prompt public health intervention directed at
limiting spread in community
Category II Reportable Diseases
 Less urgent public health importance
 Most reportable diseases fall in this category
 Reported via WEDSS (or on 4151 or 4243 for STDs)
by mail or other means within 72 hours of
identification
 Public health intervention varies depending on
disease
Category III Reportable Diseases
 HIV and AIDS
 Reported directly to state epidemiologist
 State distributes to appropriate local health
department for follow up
Communicable Disease Reporting Resources
 EpiNet manual
 DPH Communicable Disease website
including:
 Disease Fact Sheets
 Info for healthcare providers
 WEDSS (Wisconsin Electronic Disease
Surveillance System)
 Communicable disease phone contacts
 AVR (Analysis, Visualization, &
Reporting)
 Control of Communicable Diseases
Manual
Outbreak and unusual event detection
 Communicable disease reporting
 School, daycare, and worksite
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absenteeism surveillance
Local surveillance groups and
systems
Sentinel surveillance
Special event surveillance
Alerting systems
Other syndromic surveillance
systems
Sentinel Surveillance for ILI
 Wisconsin Sentinel
Clinician Program at
DPH
 Clinical surveillance for
influenza
 Clinicians report total #
of patients and # who
meet ILI case definition
 fever > 100 degrees with
cough or sore throat
Disease surveillance: Sentinel Chickens
Serology testing
Sentinel flock
Alerting Systems
 Local contact lists
 Performance measure #6
Local health department
can assure 70% of local
response partners receive
public health emergency
communication messages
 Send Word Now
 Alerting services
 Epi-X
 CIDRAP
Wisconsin Health Information
Exchange (WHIE)
 Automated, real-time data on ED (emergency
department) visits with chief complaint of:
 ‘fever-flu’ (e.g. ILI)
 GI
 respiratory (e.g. shortness of brief, wheezing etc that
don’t fit chief complaint of fever-flu)
 ‘other’ chief complaints (‘other’ = those that don’t fit in
the other categories).
WI-TRAC (Wisconsin Tracking, Resources,
Alerts and Communication)
 Wisconsin Hospital Emergency Preparedness Program
system
 Hospital alerting and communication tool
 Available to EMS, First Responders, public health,
physician offices, law enforcement, fire departments,
Dispatch Centers, and Emergency Management
directors
 Deb Van Matre, WI Trac State System Administrator,
at [email protected]
Outbreak and Unusual Events
Resources
 Communicable disease resources (WEDSS outbreak
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Food and Water Borne Disease Outbreak Investigation
manual
Wisconsin Hazardous Substances Emergency Events
Surveillance (HSEES), DHS
Emergency Preparedness and Response Surveillance,
CDC
PHEP (Public Health Emergency Program) plan
Monitor health status & disease
trends
 Disease outcomes
 Determinants and risk factors for communicable and
non-communicable disease
 Examples:
 Vaccine coverage
 Vaccine-preventable disease morbidity
 Screening rates (mammography, cholesterol)
 Smoking prevalence
 Smoking-related morbidity and mortality
Chapter 255 – Chronic Disease, Injuries, MCH
 Cancer registry - requires hospitals, physicians, and labs
to report cancer or precancerous conditions
 Injury prevention - requires DHS to:
 Maintain an injury prevention program that includes data
collection, surveillance, education, and the promotion of
intervention
 Assist local health departments and community agencies
in local program development and evaluation
 MCH:
 Identifies responsibilities for infant blindness; newborn
hearing screening; birth defect prevention and
surveillance
 Identifies responsibilities related to sudden infant death
syndrome and shaken baby syndrome and impacted
babies.
Resources for Monitoring Disease Trends
 Vital records
 Disease registries
 Surveys
 Administrative data
 Other data sources
Criteria for choosing priorities for
surveillance
 Frequency of event (incidence, prevalence, mortality)
 Severity (fatality rate, hospitalization rate, disability
rate, years of potential life lost, quality adjusted lifeyears lost)
 Cost (direct and indirect)
 Preventability
 Communicability
 Public interest
Principles and Practice of Public Health Surveillance, Teutsch, SM, Churchill, RE. 2000 Oxford University Press.
Steps in planning a Surveillance System
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Establish objectives
Develop case definitions
Determine data source or data-collection method
Develop data collection instrument (if nec)
Field-test methods (if nec)
Develop analysis approach
Decide how you will disseminate results
Ensure use of analysis and interpretation
Principles and Practice of Public Health Surveillance, Teutsch, SM, Churchill, RE. 2000 Oxford University Press.
Steps in evaluating a surveillance
system
 Clearly define the purpose and objective of the system
 Describe the operation of the system
 Document how the system has been useful
 Assess attributes of the system (timely, flexible,
representative, cost-effective, complete, simple/easy to
apply, acceptable to users, sensitive, specific)
 Estimate the cost (direct and indirect)
School Surveillance Evaluation Example
Purpose: increases the ability to detect outbreaks in a timely
way and enhance understanding of communicable diseases
circulating among school-aged children.
Operation: how system was carried out by LPHA and schools
(what data is collected, when, how, and by whom);
thresholds
Documentation of usefulness: Survey results from schools
and LPHAs, data/charts, increased communication between
school and LPHA
Assessment of attributes: Was data timely and complete?
Costs: Time of LPHA, school, consortium epidemiologists