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Public Health Surveillance Systems


Public Health Surveillance Systems Goals Review purpose of surveillance Describe types of state and local surveillance systems: Vital records Disease reporting ... – PowerPoint PPT presentation

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Title: Public Health Surveillance Systems

Public Health Surveillance Systems
  • Adverse events surveillance
  • Syndromic surveillance
  • Registries
  • Laboratory data
  • Review purpose of surveillance
  • Describe types of state and local surveillance
  • Vital records
  • Disease reporting
  • (morbidity data)
  • Surveys
  • Sentinel surveillance
  • Zoonotic disease
  • surveillance
  • Provide example of public health actions
    resulting from surveillance data

Purpose of Surveillance
  • Collecting surveillance data has many purposes
  • Monitoring disease trends
  • Detecting outbreaks
  • Providing information to plan public health
  • Stimulating research

Purpose of Surveillance
  • Specific uses of surveillance data vary depending
    on organization or agency
  • National agencies
  • Monitoring disease trends over time to inform
  • State and local agencies
  • Assuring accurate diagnosis and treatment of
    infected persons
  • Managing people exposed to disease
  • Detecting outbreaks
  • Guiding public health prevention and
    control programs

Types of State and Local Surveillance Systems
  • Surveillance systems used to monitor disease
    trends and plan public health programs
  • Vital statistics, disease reporting, surveys
  • More specialized systems
  • Sentinel surveillance, zoonotic disease
    surveillance, adverse events surveillance,
    syndromic surveillance, disease registries,
    laboratory surveillance
  • Some types more useful for certain diseases than
    others each fills a specific need

Vital Statistics
  • Records of births and deaths a basic but
    critical cornerstone of public health
  • Mortality data over past century show decrease in
    rate of deaths due to infectious diseases rate
    of death from non-infectious causes remain steady
  • Infant mortality rate (number of deaths among
    infants per 1,000 births) long used as indicator
    of overall population health
  • Birth data used to monitor incidence of preterm
    birth, risk factor for variety of adverse health

Vital Statistics
  • In United States, vital statistics available from
  • National Center for Health Statistics
  • State vital records offices
  • CDC WONDER online system containing data on
    births, deaths, many diseases from Centers for
    Disease Control and Prevention (CDC)

Disease Reporting (Morbidity Data)
  • Disease reporting required internationally by
    World Health Organization through International
    Health Regulations
  • Smallpox
  • Wild-type poliomyelitis
  • Severe acute respiratory syndrome (SARS)
  • Human influenza caused by new subtypes
  • Any public health emergency of international
  • Broad definition used to capture any disease,
    condition, event that could represent
    international risk

Disease Reporting (Morbidity Data)
  • In the United States, disease reporting mandated
    by state law
  • List of reportable diseases varies by state
  • States report nationally notifiable diseases to
    CDC on voluntary basis
  • List of notifiable diseases updated regularly by
    Council of State and Territorial Epidemiologists
    and CDC

  • Especially useful for monitoring chronic diseases
    and health-related behaviors
  • Youth Risk Behavior Survey (YRBS) asks high
    school students about substance use, sexual
    behavior, physical activity, nutrition
  • Results used to monitor trends in health
    behaviors, plan public health programs, evaluate
    public health policies at national and state

Percent of high school students who reported
smoking in the 30 days prior to the survey,
United States, 1997-2007 
  • YRBS shows decline in youth smoking from 36 in
    1997 to 20 in 2007

  • Other national surveys conducted by CDC
  • Behavioral Risk Factor Surveillance System
  • National Health Interview Survey (NHIS)
  • Pregnancy Risk Assessment Monitoring System
  • National Health and Nutrition Examination Survey

Sentinel Surveillance
  • Alternative to population-based surveillance,
  • Involves collecting data from sample of reporting
    sites (sentinel sites)
  • Example Selected health care providers report
    number of cases of influenza-like illness to
    state health department on weekly basis
  • Allows states to monitor trends using relatively
    small amount of information

Sentinel Surveillance
Percentage of visits for influenza-like illness
reported by US sentinel provider network,
2006-2007, 2007-2008
  • Graph indicates peak of influenza activity during
    2007- 2008 season in late February and
    early March (Weeks 7-9)

Sentinel Surveillance
  • Sentinel providers also used to gather more
    specific information
  • Example sentinel provider network in British
    Columbia, Canada, used in a study of vaccine
    effectiveness during 2005-2006 influenza season

Zoonotic Disease Surveillance
  • Surveillance of zoonotic diseases (diseases found
    in animals that can be transmitted to humans)
    often involves system for detecting infected
  • Example 2001 Florida surveillance for West Nile
    Virus (WNV)
  • Web site and telephone hotline to report dead
    birds, some collected and tested for WNV
  • Mosquitoes collected and tested for WNV in 10
  • Blood collected from 3-12 sentinel chickens in
    each of 212 flocks up to 4 times per month,
    tested for antibodies to WNV
  • Veterinarians asked to test horses with
    neurologic symptoms consistent with WNV
  • Health care providers reminded of reporting and
    diagnostic criteria for possible human cases of

Zoonotic Disease Surveillance
  • Surveillance systems allowed public health
    authorities to determine intensity of WNV by
    geographic area
  • Detection of WNV led to public health control
  • Advising public to protect against mosquito bites
  • Intensifying mosquito abatement efforts

Adverse Events Surveillance
  • Surveillance system focusing on patient safety
    Adverse Events Reporting System (AERS), operated
    by Food and Drug Administration (FDA)
  • Negative effects experienced by people who
    received approved drugs, therapeutic agents
  • Voluntary reports from health care providers
    (physicians, pharmacists, nurses) and public
    (patients, lawyers)
  • Health care providers/patients may report events
    directly to product manufacturer manufacturer
    required to report event to AERS
  • FDA uses AERS to identify possible safety
    concerns associated with approved products

Adverse Events Surveillance
  • Vaccine Adverse Events Reporting System (VAERS)
    also focused on patient safety operated by CDC
    with FDA
  • Like AERS, but for negative effects experienced
    by people who have received licensed vaccines
  • Used in 2003 for smallpox vaccines to health care
    and public health professionals in preparation
    for bioterrorist attack
  • gt100 adverse events reported after smallpox
    vaccination, 16 suspect and 5 probable cases of
    myocarditis or pericarditis
  • Advisory Committee on Immunization Practices
    recommended ending vaccination after health
    care and public health response teams

Adverse Events Surveillance
  • Passive surveillance systems may be limited by
    underreporting or biased reporting, cannot be
    used to determine whether a drug or vaccine
    caused a specific adverse health event
  • (See FOCUS Volume 5, Issue 5 for definitions of
    active and passive surveillance)
  • Used as early warning signals
  • Possible associations between drugs or vaccines
    and adverse events examined using well designed
    epidemiologic study, appropriate action based on

Syndromic Surveillance
  • Relatively new surveillance method, uses clinical
    information about disease signs and symptoms,
    before diagnosis is made
  • Often use electronic data from hospital emergency

Syndromic Surveillance
  • Example New York City operates syndromic
    surveillance system using emergency department
    chief-complaint data from approximately 44
  • Data monitored electronically for beginning of
    disease outbreak
  • In 2002, system detected higher than usual number
    of diarrheal and vomiting symptoms
  • Health department notified hospital emergency
    departments of possible outbreak and collected
    stool specimens, several tested positive for

Syndromic Surveillance
  • Example New York City (continued)
  • Similar outbreak later that year not detected by
    the system
  • Failure to detect attributed to incorrect coding
    of chief complaint by emergency departments
  • Illustrates potential benefits of syndromic
    surveillance, areas where changes needed to
    increase usefulness of system

  • Surveillance system used for particular
  • Often established at state level to collect
    information about persons diagnosed with
  • Example cancer registries collect information
    about type of cancer, anatomic location, stage of
    disease at diagnosis, treatment, outcomes
  • Used to improve prevention programs
  • Example women in rural areas diagnosed with
    breast cancer later than women in urban areas
    choose to promote mammography screening
    in rural areas using mobile van

Laboratory Data
  • Public health laboratories routinely conduct
    tests for viruses, bacteria, other pathogens
  • In US, labs participate in National Salmonella
    Surveillance System through electronic reporting
    of Salmonella isolates
  • 2006 gt40,000 isolates reported
  • Lab serotyping provides information about cases
    likely to be linked to common source
  • Serotypes are useful for detecting local, state,
    or national outbreaks

Laboratory Data
  • Another lab system PulseNet by CDC and
    Association of Public Health Laboratories to
    monitor foodborne illness outbreaks
  • Enables labs across US to compare pulsed-field
    gel electrophoresis (PFGE) patterns of bacteria
    from ill persons and determine similarity
  • Allows scientists to determine whether outbreak
    is occurring, even at geographically distant
  • Can decrease time required to identify outbreaks
    of foodborne illness and causes

Public Health Actions Resulting From
Surveillance Poliomyelitis
  • Global example monitoring progress toward
    eradication of poliomyelitis
  • Dramatic decrease in paralytic poliomyelitis in
    US following licensure of inactivated polio
    vaccine (1955), oral polio vaccine (1961)

Number of cases of paralytic poliomyelitis by
year, United States, 1967-1997 
Public Health Actions Resulting From
Surveillance Poliomyelitis
  • Global example monitoring progress toward
    eradication of poliomyelitis (continued)
  • Using data from countries around world, World
    Health Organization implemented intensive
    vaccination programs where decline not as

Public Health Actions Resulting From
Surveillance HIV/AIDS
  • Example surveillance for HIV/AIDS ongoing since
    detection of disease in the US in 1981
  • Data on incidence and prevalence among population
    subgroups, geographic areas important to guide
    prevention, control efforts
  • 2003-2006 estimated number of cases increased
    among men who have sex with men, remained steady
    among heterosexuals, decreased among injection
    drug users
  • Suggests that prevention programs working more
    effectively in some groups than others   

Public Health Actions Resulting From
Surveillance HIV/AIDS
  • Mapping rates shows clear pattern of higher risk
    in southeastern states than in rest of nation
  • Suggests need for more prevention measures in

Rates of diagnosed HIV/AIDS, by area of
residence, United States, 2006 
  • Many sources of public health surveillance data
    at local, state, national levels
  • Knowing where to look for different types of data
    can save time and resources
  • Data used for variety of purposes
  • Guiding prevention strategies and targeting
  • Detecting disease outbreaks of local, national,
    international significance
  • Evaluating control measures

  • National Vital Statistics System
  • Data on births, deaths, marriages, divorces,
    fetal deaths from all 50 states, 2 cities
    (Washington, DC, and New York City), 5
    territories (Puerto Rico, Virgin Islands, Guam,
    American Samoa, Commonwealth of the Northern
    Mariana Islands) much of information available
  • http//
  • User-friendly query system providing public
    health information on births, deaths, cancer
    incidence, HIV and AIDS, tuberculosis,
    vaccinations, census data
  • http//
  • Nationally Notifiable Infectious Diseases
  • List of diseases recommended for states to report
    to CDC
  • http//

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  3. World Health Organization. International health
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    Summary of notifiable diseases United States,
    2006. Morb Mortal Wkly Rep. 200855(53)1-84.
  5. Centers for Disease Control and Prevention.
    Cigarette use among high school students United
    States, 1991-2007. Morb Mortal Wkly Rep.

  1. FluView. Outpatient illness surveillance. Centers
    for Disease Control and Prevention Web site.
    http// Updated October
    10, 2008. Accessed October 14, 2008.
  2. Skowronski DM, Masaro C, Kwindt TL, et al.
    Estimating vaccine effectiveness against
    laboratory-confirmed influenza using a sentinel
    physician network results from the 2005-2006
    season of dual A and B mismatch in Canada.
    Vaccine. 200725(15)2842-2851.
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    Brooks RG, Conti LA, Wiersma ST. Surveillance
    results from the first west nile virus
    transmission season in Florida, 2001. Am J Trop
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  4. Food and Drug Administration, Center for Drug
    Evaluation and Research. Adverse Event Reporting
    System (AERS) Web site. http//
    rs/default.htm. Published August 7, 2002.
    Updated September 5, 2008. Accessed November 21,

  1. Zhou W, Pool V, Iskander JK, et al. Surveillance
    for safety after immunization vaccine adverse
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    1991-2001. MMWR CDC Surveill Summ.
  2. Centers for Disease Control and Prevention.
    Update adverse events following civilian
    smallpox vaccination United States, 2003. Morb
    Mortal Wkly Rep. 200453(5)106-107.
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    Advisory Committee on Immunization Practices
    (ACIP) statement on smallpox preparedness and
    vaccination. http//
    vaccination/acipjun2003.asp. Published June 18,
    2003. Accessed October 23, 2008.
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