Norbert Boruett-Innovating in Medical Education

12 replies to “Disease surveillance

  1. INTRODUCTION TO PUBLIC HEALTH SURVEILLANCE
    1. DEFINITION
    Public health surveillance is the ongoing systematic collection, analysis, and interpretation of health – related data essential to planning, implementation and evaluation of public health practice, closely integrated with the timely dissemination of these data to those responsible for prevention and control.
    The goal of public health surveillance is to provide information that can be used for health action by public health personnel, government, leaders, and the public to guide public health policy and programs.
    2. ROLE & USES OF PUBLIC HEALTH SURVEILLANCE
    The roles and uses of PHS include;
     -Identifying patients and their contacts for treatment and intervention;
     -Detecting epidemics, health problems, changes in health behaviours;
     -Estimating the magnitude and scope of health problems;
     -Measuring trends and characterize disease;
     -Monitoring changes in infectious and environmental agents;
     -Assessing effectiveness of programs and control measures;
     -Developing hypothesis and stimulating research.
    3. PUBLIC HEALTH APPROACH
    -Surveillance; identify the problem by using surveillance system to manage health events.
    -Risk factor identification; identifying factors that make people susceptible to diseases.
    -Intervention evaluation; what intervention work to address the problem by looking at what worked -in the past to address the same problem
    -Implementation; how to implement the intervention with given resources and population?
    -The public health core sciences include; public health surveillance, epidemiology, laboratory, informatics, and prevention effectiveness.
    4. PUBLIC HEALTH SURVEILLANCE TYPES &ATTRIBUTES
     a. Passive surveillance
    Diseases are reported by health care providers. This type of surveillance deals with all routine notifiable diseases. It is simple to use and inexpensive but limited by incompleteness of reporting and variability of quality.
     b. Active surveillance
    Regular outreach to potential reporters to stimulate reporting of specific diseases or injuries. This can be used to validate the representative of passive surveillance. Health agencies contact health providers seeking report. Active surveillance ensures more complete reporting of conditions. It is used in conjunction with specific epidemiologic investigation.
     c. Sentinel surveillance
    Reporting of health events by health professionals who are selected to represent a geographic area or a specific reporting group.
     d. Syndromic surveillance
    Focuses on one or more symptoms rather than a physician- diagnosed or laboratory- confirmed diseases.
    KEY SURVEILLANCE SYSTEM ATTRIBUTES
     -Usefulness
    Answer the question, how useful is the system in accomplishing its objective?
     -Data quality
    Answer the question; how reliable are the available data? And how complete and accurate are data field in the report received by the system?
     -Timeliness
    Answer the question; how quickly are report received?
     -Flexibility
    Answer the question; how quickly can the system adopt to changes?
     -Simplicity
    Answer the question; how easy is the system’s operation?
     -Stability;
    Answer the question; does the surveillance system works well? And does it break down often?
     -Sensitivity
    Answer the question; how well does capture the intended cases?
     -Predictive value positive
    Answer the question; how many of the reported cases meet the case definition?
     -Representativeness
    Answer the question; how good is the system at representing the population under surveillance?
     -Acceptability
    Answer the question; how easy is the system’s operation?
    5. PUBLIC HEALTH SURVEILLANCE LEGAL BASIS
     Legal authority for conducting PHS
    The states have authority based on the U.S constitution
    -General welfare clause
    -Interstate commerce clause
    CDC only responds when;
    -Disease or condition has interstate implication
    -Invited by the state.
    State based notifiable disease surveillance system
    -Mandated by state law or regulation
    -Healthcare providers, hospitals, laboratories are required to report cases to the local health department,
    -The local health department is usually responsible for case investigation and action,
    -The local health department forward the disease report to the state of health department,
    -And the state of health department assists the local health department as needed.
    6. PUBLIC HEALTH SURVEILLANCE PROCESS
     a. Data collection; before collecting data, decide on the overarching goal of the system, what the specific objectives might be.
    The data sources include; reported diseases or syndromes, electronic health records, hospital discharge data, vital record (i.e. birth and death certificate), and surveys
     b. Data analysis
    Who will analyse the data?, what methodology will they use? And how often will they analyse the data?
     c. Data interpretation
    This is closely related to data analysis by identifying the person, place, and time to determine how and why the health event occur.
     d. Data dissemination
    How is the information going to be distributed? , medical and epidemiology journal articles and press release as well as social media.
    The target audiences include; public health practitioners, clinicians and other healthcare providers, policy and decision makers, community organizations, and the general public.
     e. Link to action
    Without action the collected data has no real purpose. Public health system should always have a link to action.
    Public health based actions include;
    -Describe the burden of or potential for disease
    -Monitor trends and patterns in disease, risk factors and agents
    -Detect sudden changes in disease occurrence and distribution
    -Provide data for programs, policies and proprieties
    -Evaluate prevention and control efforts.

    Like

  2. 29/11/2019
    Summary of Raph Cordell, Ph D Epidemiologist presentation. Division of scientific education, who has worked in public health for almost 40 years.
    Topic 1: Importance of surveillance
    Public surveillance is one of the most important aspects of public health systems used to address problems through experience and sharing. It gives structure and purpose to daily activities of local health department. Data drives our decisions and actions and basics of surveillance include types, attributes and the process.
    Public health approach to problem solving
    Public health problems are adverse and include infectious diseases, chronic, emergency injuries and mental health problems.
    Four approaches
    1. Identification of the problem
    2. Cause of the problem
    3. Type of intervention that works
    4. How to implement the intervention, the resources available and information about the affected population known
    Core disciplines that represent the foundation P. H approach
    • Public health surveillance monitors situations
    • Epidemiology helps us understand origin of disease, how and why they spread, and preventive measure
    • Public health laboratories perform tests to confirm disease diagnosis and investigations.
    • Informatics deal with data collection methods, compilation and preservation of health education. Electronic data is readily available for use.
    • Prevention effectiveness is closely linked to public health policy. Its study enables decision maker to opt for the best measure. (Is this juice worth the squeeze?).
    Together, these five core sciences can help protect and promote public health by giving practitioners the answers they need.
    Topic 2: Public health surveillance
    An ongoing, systematic collection, analysis and interpretation of health related data essential to planning, implementation and evaluation of public health practice, closely linked with the timely dissemination of these, data to those responsible for prevention and control.
    ‘Ongoing’ distinguishes surveillance from research, which is tied down to duration of study
    Why do surveillance?
    The goal is to provide information that can be used for health action:
    Topic 3: Role and uses
    • Identifies patients and their contacts for treatment and intervention – STI’s, hepatitis A
    • Detects epidemic, health problems and changes in health behaviours,
    • Estimates the magnitude of health problems – both are alarm function of surveillance although behaviour changes maybe for the good.
    • Measure trends and characterize disease – identify population at high risk, and target specific group
    • Monitor changes in infections and environmental agents – data has helped to identify the speed of emergent infections like the west Nile, and to monitor increase in microbial resistance
    • Assess effectiveness of programmes and control measures
    • Develop hypothesis and stimulate research
    A few headlines from the past (National monitoring system for foodborne illness)
    • Whooping cough kills five in California, state declares epidemic.
    • New CDC report shows adult obesity growing or holding steady in all states
    • Increase seen in deaths from pneumonia and flu
    • Number of rare E.coli cases in U.S rose last year
    • Percentage of new Yorkers lighting up is down to 14%
    – How do we know an epidemic is coming?
    – How can we know that cases are reducing or increasing?
    Surveillance answers all these questions.
    Topic 4: Public health surveillance legal basis
    The U.S constitution states that the legal authority for P.H including surveillance resides with the state. The federal government is charged with promoting general welfare of the people. It has authority over interstate commerce.
    Notifiable disease reporting system
    Reportable disease systems are mandated by legislators through state of law. A state health officer can also be given authority to mandate reporting of specific diseases or conditions.
    Topic 5: Types and attributes of public health surveillance
    Surveillance is divided into 2 categories, passive and active.
    Passive
    The physician, laboratory or other health care providers take the initiative to provide information on reportable diseases. The health agencies wait for reports, it is simple, inexpensive but is limited by incompleteness and variability of quality.

    Active
    Active surveillance is used to validate the representative of passive reporting. Enhances more complete reporting in conjunction with epidemiological investigations.
    Used for direct purposes e.g. outbreak or special time limited events and special interest such as SARS (Severe Acute Respiratory infection).
    Others; sentinel and syndromic, which focuses on one or more symptoms rather than physician – diagnosed or laboratory confirmed disease.
    Surveillance system attributes
    • Usefulness
    • Data quality
    • Timeliness
    • Flexibility
    • Simplicity
    • Stability
    • Sensitivity
    • Predictive value positive
    • Representativeness of population
    • Acceptability
    Topic 6: Public health surveillance process
    Decisions made to place an illness or injury under public health surveillance deal with the process, overarching goal and objectives. The 5 steps are; data collection, analysis, interpretation, dissemination and follow up action.
    1. Data collection – questions include what to monitor, what data, definitions and data fields, reason, systems and how to use it. Others are; personnel, method of collection, target population, type of surveillance, place, transmission channel, stakeholders and quality.
    Data sources
    • Reported disease and syndromes
    • Electronic health records
    • Vital records
    • Registries
    • Surveys e.g. Nutritional
    2. Data analysis – this involves who will analyze the data, methodology and how often. Analysis is done by person, sex, race and county of origin,
    3. Data interpretation is closely coupled with analysis and can determine how and why the health event occurred.
    4. Data dissemination tells us how we are going to distribute information to those who need it. Target audience; public health practitioners, clinicians, policy and decision makers, community organizations and general public.
    5. Link to action – without response, data serves no purpose. A group on monitoring of trends and disease patterns in the US 1922, were able to change their recommendation regarding pertussis vaccine, to include adults for prevention of spread.
    National notifiable disease system
    Each state determines which diseases are reportable. CDC publishes the provisional data weekly, then annually. This allows states to compare population’s health with others.
    P. H surveillance based action
    • Describing disease burden
    • Monitoring of trends, patterns and risks
    • Detecting sudden changes and distribution
    • Providing data for programmes, policies and priorities, and evaluating prevention and control.
    Bill Fahy, Former CDC director sums up by saying “surveillance should not consume resources if action does not follow up“ (William Foege 1976). Need to learn more about surveillance.
    SHS/BCH/189 – 2/2018.

    Like

  3. INTRODUCTION TO PUBLIC HEALTH SURVEILLANCE.
    A PUBLIC HEALTH APPROACH.
    1. Surveillance – what is the problem?
    2. Risk factor identification – what is the cause?
    3. Intervention evaluation – what works effectively?
    4. Implementation – how do you do it?
    DEFINITION
    The 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.
    GOAL.
    Provide information that can be used for health action by public health personnel, government leaders and the public to guide public health policy and programs.
    ROLE AND USES OF PUBLIC HEALTH SURVEILLANCE.
    1. Identify patients and their contacts for treatment and intervention.
    2. Detect epidemics, health problems, changes in health behaviors.
    3. Estimate magnitude and scope of health problems.
    4. Measure trends and characterize disease.
    5. Monitor changes in infectious and environmental agents.
    6. Assess effectiveness of programs and control measures.
    7. Develop hypotheses and stimulate research.
    TYPES OF PUBLIC HEALTH SURVEILLANCE.
    1. Active surveillance – it is a type of surveillance that is mostly used during outbreaks where health agencies contact health providers seeking reports. It ensures more complete reporting of conditions and is used in conjunction with specific epidemiological investigation.
    2. Passive surveillance – is a type of surveillance that is reported by health care providers. It is a simple and inexpensive method. It is limited by incompleteness of reporting and variability of quality.
    3. Sentinel surveillance – reporting of health events by health professionals who are selected to represent a geographic area or a specific reporting group. It can be passive or active.
    4. Syndromic surveillance – focuses on one or more symptoms rather than a physician diagnosed or laboratory confirmed disease.
    SURVEILLANCE SYSTEM ATTRIBUTES.
    1. Usefulness – how useful is the system in accomplishing its objectives?
    2. Data quality – how reliable are the available data? How complete and accurate are data fields in the reports received by the system?
    3. Timeliness – how quickly are reports received?
    4. Flexibility – how quickly can the system adapt to changes?
    5. Simplicity – how easy is the system’s operation?
    6. Stability – does the surveillance system work well? Does it breakdown often?
    7. Sensitivity – how well does it capture the intended cases?
    8. Predictive value positive – how many of the reported cases meet the case definition?
    9. Representativeness – how good is the system at representing the population under surveillance?
    10. Acceptability – how easy is the system’s operation?
    PUBLIC HEALTH SURVEILLANCE PROCESS
    a) Data collection
    Before data collection, decide what over arching goal of the system. Some of the data sources include reported diseases or syndrome, electronic health records, vital records, registries, surveys.
    b) Data analysis
    Who will analyze the data? What methodology will they use? how often will they analyze the data?
    c) Data interpretation
    This is done after analysis to determine how and why the health event occurred.
    d) Data dissemination
    This is providing feedback to the relevant health authorities for required action. Some of the data dissemination target audience include: public health practitioners and clinicians.
    e) Link to action
    The data disseminated to the relevant audiences should be used for prevention and control action. Some of the surveillance based actions include:
    i. Describe the burden of or potential of disease.
    ii. Monitor trends and patterns in disease, risk factors and agents.
    iii. Detect sudden changes in disease occurrence and distribution.
    iv. Provide data for programs, policies and priorities.
    v. Evaluate prevention and control efforts.

    Like

  4. SHS/BCH/194-2/2018

    PUBLIC HEALTH SURVEILLANCE
    INTRODUCTION
    Public health surveillance is the ongoing, systematic collection, analysis and interpretation of health-related data.
    Examples of public health problems include: chronic diseases, infectious diseases, emergencies, injuries and environmental health problems.
    The overall goal of surveillance is to provide information to be used for public health action such as policy making and programs.
    PURPOSE OF PUBLIC HEALTH SURVEILLANCE
    1. To identify patients and their contacts for treatment and intervention
    2. Detect outbreaks, health problems and changes in health behavior
    3. Measures trends and pattern of disease
    4. Monitor changes in infectious and environmental agents
    5. Assess effectiveness of programs and control measures
    6. Develop hypothesis
    7. Stimulate research
    PUBLIC HEALTH APPROACHES
    These steps are used so as to eliminate the differences found in the health among different groups of people.
    1. Surveillance (What is the problem?)
    • By using surveillance systems, we are able to monitor health events
    2. Risk factor (What is the cause?)
    • Uses epidemiology to identify these factors which could be environmental or behavioral
    3. Intervention evaluation (What works?)
    • You get to know what actions have been taken in the past to address the same health problems and reasons as to why they did not work
    4. Implementation (How do you do it?)
    • We use the information we know about the population
    DISCIPLINES USED IN PUBLIC HEALTH APPROACHES
    1. Surveillance
    2. Epidemiology
    3. Informatics
    4. Laboratory
    5. Prevention effectiveness
    PUBLIC HEALTH LEGAL BASIS
    Health care providers, hospitals, laboratories report cases that need to be notifiable
    WHO notifiable diseases are:
     Small pox
     Poliomyelitis
     Human influenza
     Severe acute respiratory syndrome (SARS)
    TYPES OF PUBLIC HEALTH SURVEILLANCE
    1. Active surveillance
    • This is community based and ensures more complete reporting
    • Health agencies contact health providers for reports
    • Used together with specific epidemiological investigations
    2. Passive surveillance
    • This is hospital based and hence is simple and inexpensive
    • Limited by incompleteness of reporting
    • Diseases are reported by health care providers
    3. Sentinel surveillance
    • Can be active or passive
    • Reporting of health events by the health personnel who represent certain locations that are more susceptible to health problems
    4. Syndromic surveillance
    • Focuses on the signs and symptoms
    • Follow ups are necessary
    • Are mostly used for early detection e.g. of bio-terrorism
    When evaluating a surveillance system there are some considerations:
     Usefulness
     Data quality
     Timeliness
     Simplicity
     Stability
     Flexibility
     sensitivity
     Predictive value
     Representativeness
     Acceptability
    PUBLIC HEALTH SURVEILLANCE PROCESS
    1. Establish an overall goal that has specific objectives
    2. Data collection
    3. Data analysis
    4. Data interpretation
    5. Data dissemination
    6. Link to action (follow ups)
    SOURCES OF DATA :
     Reported diseases i.e. those of importance to public health e.g. polio
     Electronic health records e.g. medical history of a patient
     Vital records e.g. birth and death certificates
     Registries e.g. immunizations
     Surveys
    CONCLUSION
    Public health surveillance helps in identification of health emergencies, guide in coming up with health strategies, understand and monitor the epidemiology of a condition and be able to undertake disease prevention and control measures.

    Like

  5. SHS/BCH/190-2/2018
    PUBLIC HEALTH SURVEILLANCE
    Public health problems are diverse and include infectious diseases, emergencies, injuries, environmental health.
    Public health surveillance is an ongoing, systematic collection, analysis and interpretation of health related data essential to planning, implementation and evaluation of public health practice closely integrated with timely dissemination of these data to those responsible for prevention and control.
    The goal is to provide information that can be used for health action by public health personnel, government leaders and the public to guide public health policy and programs.
    ROLE OF PUBLIC HEALTH SURVEILLANCE
    1. Identify patients and their contacts for treatment and intervention.
    2. Detect epidemics, health programs changes in health behaviors.
    3. Measure trends and characterize diseases.
    4. Monitor changes in infectious and environmental agents.
    5. Estimate magnitude and scope of health problems
    6. Assess effectiveness of programs and control measures.
    7. Develop hypotheses and stimulate research.
    Public health surveillance legal basis ensures that the mandate of data collection and reporting is controlled by the state law or regulation.
    Thus, healthcare providers, hospitals and laboratories are required to report cases to the local health department which is responsible for case investigation and action.
    TYPES OF SURVEILLANCE
    • Passive surveillance – where diseases are reported by health care providers and may take place within a health facility.
    • Active surveillance-where health agencies conduct epidemiologic investigations alongside health agencies in order to come up with health reports.
    • Sentinel surveillance-combines active and passive where health personnel are selected to represent a geographic area that is likely to be a representation of the entire population.
    • Syndromic surveillance-focuses on one or more symptoms rather than laboratory confirmed disease.
    ATTRIBUTES OF A SURVEILLANCE SYSTEM
     Usefulness- the ability of the system to accomplish its objectives.
     Data quality-reliability of the available data
     Sensitivity- ability to capture the intended cause
     Timeliness-the period of where the data can be generated and used for the study.
     Flexibility-adaptability of the system to changes.
     Predictive value positive- the number of times the reported cases meet the case definitions.
     Simplicity-ease in operation of the system
     Stability-ability of the surveillance to function properly without breaking down.
     Representative-process of representing the population under surveillance
     Acceptability-the process where people have socially accepted the use of a particular method in health to assure health benefiting outcomes.
    SURVEILLANCE PROCESS
    Data collection
    Data analysis
    Data interpretation
    Data dissemination
    Link to action.
    SOURCES OF DATA.
    Reported diseases or syndromes
    Electronic health records
    Vital records
    Registries
    Surveys.

    Like

Leave a Reply to SHS/BCH/181-2/2018 Cancel reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.

%d bloggers like this:
close-alt close collapse comment ellipsis expand gallery heart lock menu next pinned previous reply search share star