Transcript - Foundations of Public Health, Epidemiology, and

U N I V E R S I T Y O F M I C H I G A N
Surveillance
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S C H O O L O F D E N T I S T R Y
U N I V E R S I T Y O F M I C H I G A N
Definition
• Ongoing systematic collection, analysis,
and interpretation of outcome-specific
data for use in planning,
implementation, and evaluation of public
health practice
– CDA/Agency for Toxic Substance and
Disease Registry
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S C H O O L O F D E N T I S T R Y
U N I V E R S I T Y O F M I C H I G A N
Definition
• Functional capacity
– Data collection
– Analysis
– Timely dissemination of information derived
from the data to persons who can
undertake effective prevention and control
activities.
• Surveillance should be tied to health
outcomes
– It is not just the collection of data
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S C H O O L O F D E N T I S T R Y
U N I V E R S I T Y O F M I C H I G A N
Pre-requisites
• Organized healthcare system
• Classification system for diseases
• Early surveillance systems relied on
mortality statistics
– Disease specific death counts and rates
– Disease patterns
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S C H O O L O F D E N T I S T R Y
U N I V E R S I T Y O F M I C H I G A N
Surveillance and Public Health
• Uses:
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Estimating the burden of diseases
Understanding the natural history
Detecting of epidemics
Facilitating of epidemiologic or laboratory research
Testing hypotheses
Evaluating of control and prevention measures
Monitoring changes in infectious diseases
Monitoring isolation activities
Detection of changes in health practice
Planning
S C H O O L O F D E N T I S T R Y
U N I V E R S I T Y O F M I C H I G A N
Public Health
• William Farr (1807-1883)
– Founder of surveillance
– Vital statistics
– Reporting on causes of death to health
authorities and public
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S C H O O L O F D E N T I S T R Y
U N I V E R S I T Y O F M I C H I G A N
Surveillance in the US
• Infectious diseases
– Rhode Island in 1741
– Tavern keepers are required to report on contagious
diseases
– 1743: reporting of smallpox, yellow fever, and cholera
– 1850: mortality statistics based on death registration and the
decennial census were first published by the federal
government for the entire US
– 1874: systematic reporting of disease in Massachusetts:
State Board of Health instituted a voluntary plan for
physicians to provide weekly reports on prevalent diseases
using a postcard-size reporting form.
– 1878: Congress authorized the collecting of morbidity data
for use in quarantine measures against such diseases as
cholera, smallpox, plague, and yellow fever.
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S C H O O L O F D E N T I S T R Y
U N I V E R S I T Y O F M I C H I G A N
Surveillance in the US
• In 1925, following the flu pandemic and
poliomyelitis
– All states participated in a national
morbidity reporting system
• A national health survey was conducted
in 1935
• 1949 weekly statistics
• 1961: CDC responsible for reporting
mortality and morbidity reports
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S C H O O L O F D E N T I S T R Y
U N I V E R S I T Y O F M I C H I G A N
Surveillance in the US
• Council of State and Territorial Epidemiologists
decide on what health conditions should be reported
about by state to the PHS.
• In 1955 in the Francis Field Trial of Poliomyelitis, six
cases of paralysis associated with polio were
reported; and all cases were traced to the vaccine
produced by a single manufacturer.
• Intensive investigation found 141 cases of vaccineassociated paralytic polio, 80 of which represented
family contacts with vaccinated individuals.
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S C H O O L O F D E N T I S T R Y
U N I V E R S I T Y O F M I C H I G A N
Steps in Planning a Surveillance
System
• Establish objectives
• Develop case definitions
• Determine data sources or data-collection
mechanisms (type of system)
• Develop data-collection instruments
• Field-test methods
• Develop and test analytic approach
• Develop dissemination mechanism
• Ensure use of analysis and interpretation
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S C H O O L O F D E N T I S T R Y
U N I V E R S I T Y O F M I C H I G A N
National Oral Health Surveillance
System (NOHSS)
• Collaborative effort between CDC's Division
of Oral Health and the Association of State
and Territorial Dental Directors (ASTDD).
• Designed to help public health programs
monitor the burden of oral disease, use of the
oral health care delivery system, and the
status of community water fluoridation on
both a state and national level.
• Includes indicators of oral health, information
on state dental programs, and links to other
important sources of oral health information.
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S C H O O L O F D E N T I S T R Y
U N I V E R S I T Y O F M I C H I G A N
NOHSS
• Dental Visits. Percentage of people who
visited the dentist or dental clinic within
the past year. Routine dental visits aid in the
prevention, early detection and treatment of
tooth decay, oral soft tissue disease, and
periodontal diseases.
• Teeth Cleaning. Percentage of people who
had their teeth cleaned in the past year.
Having one's teeth cleaned by a dentist or
dental hygienist is indicative of preventive
behavior.
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S C H O O L O F D E N T I S T R Y
U N I V E R S I T Y O F M I C H I G A N
NOHSS
• Complete Tooth Loss.
Percentage of people aged 65 years and older
who have lost all natural permanent teeth. Loss of all natural permanent teeth
(complete tooth loss) may substantially reduce quality of life, self-image, and
daily functioning.
• Fluoridation Status. Percentage of people served by public water
systems who receive fluoridated water. Water fluoridation plays an important
role in reducing tooth decay and tooth loss.
• Caries Experience. Percentage of 3rd grade students with caries
experience, including treated and untreated tooth decay. Dental caries is the
single most common chronic disease of childhood, occurring five to eight times
as frequently as asthma, the second most common chronic disease in children.
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S C H O O L O F D E N T I S T R Y
U N I V E R S I T Y O F M I C H I G A N
NOHSS
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Untreated Tooth Decay. Percentage of 3rd grade students with untreated tooth
decay. To avoid pain and discomfort, decayed teeth need to be restored (filled).
To keep as much of the natural tooth as possible, decayed teeth should be
discovered early and repaired promptly so that fillings may be kept small.
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Dental Sealants. Percentage of 3rd grade students with dental sealants on at
least one permanent molar tooth. Plastic coatings applied to decay-susceptible
tooth surfaces (the pits and fissures) reduce tooth decay, have been approved
for use for many years, and are recommended by professional health
associations and public health agencies, particularly for children at high risk for
tooth decay.
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Cancer of the Oral Cavity and Pharynx. Oral and pharyngeal cancer
comprises a diversity of malignant tumors that affect the oral cavity and pharynx
(mouth and throat). Each year, some 30,000 new cases of oral and pharyngeal
cancer are diagnosed and 8,000 people die from the disease. For more
information on oral cancer,
S C H O O L O F D E N T I S T R Y
U N I V E R S I T Y O F M I C H I G A N
Suggested Surveillance Program
for Community Health centers
• Percentage of patients who receive full diagnosis and treatment
– Untreated decay
– Periodontal diseases
– Oral cancer screening and referral, when needed
• Percentage of patients who are assessed for risk of developing
caries, periodontal diseases, and oral cancer
• Percentage of patients who receive tailored preventive
programs
• Percentage of patients who are recalled
• Percentage of patients who are recalled based on their risk
status
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S C H O O L O F D E N T I S T R Y