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Benefits of Public Health Surveillance in Epidemiology

This overview discusses the applications of public health surveillance, including data collection, analysis, and dissemination for planning, evaluating public health practices. It highlights uses such as estimating problem magnitude, detecting outbreaks, generating hypotheses, and evaluating control measures. Examples like Shigellosis and Hepatitis A rates are explored. The document emphasizes the role of surveillance in understanding disease distribution, natural history, spread, and facilitating targeted planning. Measles and Poliomyelitis cases are evaluated over time to showcase surveillance impact.

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Benefits of Public Health Surveillance in Epidemiology

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  1. Overview of Uses for Public Health Surveillance Daniel M. Sosin, M.D., M.P.H. Division of Public Health Surveillance and Informatics Epidemiology Program Office

  2. Public Health Surveillance • Ongoing, systematic collection, analysis, and interpretation of health-related data and dissemination for use in the planning, implementation, and evaluation of public health practice.

  3. Uses of Public Health Surveillance • Estimate magnitude of the problem • Portray the natural history of a disease • Determine distribution and spread of illness • Detect outbreaks • Generate hypotheses, stimulate research • Evaluate control and prevention measures • Monitor changes in infectious agents • Detect changes in health practices • Facilitate planning

  4. Uses of Public Health Surveillance • Estimate magnitude of the problem • Portray the natural history of a disease • Determine distribution and spread of illness • Detect outbreaks • Generate hypotheses, stimulate research • Evaluate control measures • Monitor changes in infectious agents • Detect changes in health practices • Facilitate planning

  5. 15 10 Reported cases per 100,000 population 5 0 1968 1973 1978 1983 1988 1993 1998 Year Shigellosis1968-1998 Source: CDC. Summary of notifiable diseases. 1998.

  6. Uses of Public Health Surveillance • Estimate magnitude of the problem • Portray the natural history of a disease • Determine distribution and spread of illness • Detect outbreaks • Generate hypotheses, stimulate research • Evaluate control measures • Monitor changes in infectious agents • Detect changes in health practices • Facilitate planning

  7. 160 National Center for Infectious Diseases (NCID) data* National Electronic Telecommunications System for Surveillance (NETSS) data 140 TOXIC SHOCK SYNDROME (TSS) United States, 1983-1998 120 Reported cases 100 80 60 40 20 0 1992 1989 Year (Quarter) 1983 1984 1986 1987 1988 1990 1991 1993 1994 1995 1996 1997 1998 *Includes cases meeting the CDC definition for confirmed and probable cases for staphylococcalTSS. 1985

  8. Uses of Public Health Surveillance • Estimate magnitude of the problem • Portray the natural history of a disease • Determine distribution and spread of illness • Detect outbreaks • Generate hypotheses, stimulate research • Evaluate control measures • Monitor changes in infectious agents • Detect changes in health practices • Facilitate planning

  9. Rate of Hepatitis AUnited States, 1998 NYC DC PR NA VI GUAM AM SAMOA NA NA CNMI >20.0 < 5.0 5.0–9.9 10.0–19.9 Source: CDC. Summary of notifiable diseases. 1998.

  10. Uses of Public Health Surveillance • Estimate magnitude of the problem • Portray the natural history of a disease • Determine distribution and spread of illness • Detect outbreaks • Generate hypotheses, stimulate research • Evaluate control measures • Monitor changes in infectious agents • Detect changes in health practices • Facilitate planning

  11. 110 100 90 80 70 60 50 40 30 20 10 0 Botulism (Foodborne)United States, 1978-1998 Laboratory-confirmed cases* NETSS data Outbreak caused by potato salad, NM Outbreak caused by sautéed onions, IL Outbreak caused bybaked potatoes, TX Outbreak caused by fermented fish/sea products, AK Reported cases 1978 1983 1988 1993 Year 1998 Source: CDC. Summary of notifiable diseases. 1998. *Data from survey of state epidemiologists and directors of state public health laboratories. Not yet available for 1998.

  12. Uses of Public Health Surveillance • Estimate magnitude of the problem • Portray the natural history of a disease • Determine distribution and spread of illness • Detect outbreaks • Generate hypotheses, stimulate research • Evaluate control measures • Monitor changes in infectious agents • Detect changes in health practices • Facilitate planning

  13. MEASLES (Rubeola) United States, 1963-1998 500 MEASLES — by year, United States, 1983–1998 450 30 25 400 20 Reported Cases (Thousands) 15 350 10 300 5 0 250 1983 1988 1993 1998 200 Year 150 100 50 0 1963 1968 1973 1978 1983 1988 1993 1998 Vaccine licensed Reported cases (thousands) Year Source: CDC. Summary of notifiable diseases. 1998.

  14. Uses of Public Health Surveillance • Estimate magnitude of the problem • Portray the natural history of a disease • Determine distribution and spread of illness • Detect outbreaks • Generate hypotheses, stimulate research • Evaluate control measures • Monitor changes in infectious agents • Detect changes in health practices • Facilitate planning

  15. 60 55 50 1000 45 100 40 10 1 35 0.1 30 0.01 0.001 25 1951 1956 1961 1966 1971 1976 1981 1986 1991 1996 20 15 10 5 0 1968 1973 1978 1983 1988 1993 1998 Poliomyelitis (Paralytic) United States, 1968-1998 Inactivated Vaccine Oral Vaccine Rate/100,000 Population Reported cases Year NOTE: Inactivated vaccine was licensed in 1955. Oral vaccine was licensed in 1961. Year Source: CDC. Summary of notifiable diseases. 1998.

  16. Uses of Public Health Surveillance • Estimate magnitude of the problem • Portray the natural history of a disease • Determine distribution and spread of illness • Detect outbreaks • Generate hypotheses, stimulate research • Evaluate control measures • Monitor changes in infectious agents • Detect changes in health practices • Facilitate planning

  17. PPNG 12 TRNG 10 PPNG & TRNG 8 6 4 2 0 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 Trends in Plasmid-Mediated Resistance to Penicillin and Tetracycline United States, 1988-1997 Source: Gonococcal Isolate Surveillance Project (GISP) Percent Year Note: "PPNG" (penicillinase-producing ) and "TRNG" (tetracycline-resistant) N.gonorrhoeae refer to plasmid-mediated resistance to penicillin and tetracycline, respectively.

  18. Uses of Public Health Surveillance • Estimate magnitude of the problem • Portray the natural history of a disease • Determine distribution and spread of illness • Detect outbreaks • Generate hypotheses, stimulate research • Evaluate control measures • Monitor changes in infectious agents • Detect changes in health practices • Facilitate planning

  19. Breast Cancer Screening

  20. Uses of Public Health Surveillance • Estimate magnitude of the problem • Portray the natural history of a disease • Determine distribution and spread of illness • Detect outbreaks • Generate hypotheses, stimulate research • Evaluate control measures • Monitor changes in infectious agents • Detect changes in health practices • Facilitate planning

  21. 20,000 U.S.-born 16,000 Reported cases 12,000 8,000 4,000 Year 0 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 Tuberculosis United States, 1986-1998 (U.S.- and foreign-born persons) Foreign-born Source: CDC. Summary of notifiable diseases. 1998.

  22. Uses of Public Health Surveillance • Estimate magnitude of the problem • Portray the natural history of a disease • Determine distribution and spread of illness • Detect outbreaks • Generate hypotheses, stimulate research • Evaluate control and prevention measures • Monitor changes in infectious agents • Detect changes in health practices • Facilitate planning

  23. Surveillance for Outbreak Detection • Convergence of technology, volumes of electronic data, and new priority for early detection • Increase timeliness and completeness of routine data • Capture nontraditional data that signify a condition before a diagnosis is made • Analytic methods to detect smaller signals

  24. Surveillance for Outbreak Detection: Experience • Laboratory specificity to detect clusters • Sentinel systems with resources to monitor and investigate • Syndrome surveillance where outbreaks are substantial and predictable • Case reports trigger outbreak investigation

  25. Surveillance for Outbreak Detection: Exploration • Enhanced reporting from clinical sites (ED, EMS, 911, offices) • Health care transaction warehouses (pharmacy, patient encounters, lab orders) • Novel data sources (retail sales, veterinary encounters, environmental indicators, absenteeism) • Signal detection methods

  26. Surveillance for Outbreak Detection: Reality • Human “technology” is key • Single case detection depends on clinical acumen and reporting relationships • Epidemiologic judgment in evaluating volumes of data • Follow-up of system signals • Tolerance for false alarms will vary

  27. Surveillance Research Needs • Achieving the National Electronic Disease Surveillance System (NEDSS) architecture • Data fusion (linkage) • New data sources • Case definitions (automation/validation) • Geographic Information System (GIS) indices • Forecasting • Evaluation and quality control

  28. Resources • www.cdc.gov/cic • www.cdc.gov/epo/dphsi/phs.htm • www.cdc.gov/epo/dphsi/phs/syndromic.htm • dsosin@cdc.gov

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