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Public Health Surveillance

Public Health Surveillance. Ashry Gad Mohamed MB.ChB, MPH, DrPH Prof. of Epidemiology. Contents. Definition Importance Elements Objectives Types Procedures of data collection Analysis Action Reports. Public Health Surveillance.

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Public Health Surveillance

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  1. Public Health Surveillance Ashry Gad Mohamed MB.ChB, MPH, DrPH Prof. of Epidemiology

  2. Contents • Definition • Importance • Elements • Objectives • Types • Procedures of data collection • Analysis • Action • Reports

  3. Public Health Surveillance “Ongoing systematic collection, analysis, and interpretation of outcome-specific data for use in the planning, implementation, and evaluation of public health practice.” CDC

  4. Surveillance System Data Collection Analysis Dissemination

  5. Surveillance for communicable diseases remains important… • The world population is highly mobile • International travel and troop movements increase the risk of communicable disease transmission • Migration for war and famine, and voluntary immigration increase communicable disease risk • Naturally occurring disease is not our only threat

  6. Elements of surveillance • Cases and deaths due to a given disease. • Laboratory results. • Prevention and control measures. • Environment. • Vector. • Reservoir. • Population

  7. Conceptual Taxonomy Public Health Surveillance Medical Utilization and Adverse Events Disease Drug Vaccine Other Products/Services Traditional ‘Syndromic’ Infectious Disease Other Birth defect Injuries Etc.

  8. Objectives of surveillance • Identify diseases of public health importance. • Identify quickly any outbreak, epidemic or unusual event. • Identify risk factors. • Identify high risk population. • Monitor disease trend. • Access current disease control activities.

  9. What data do we collect? • Should be preceeded by careful selection of diseases or conditions. • Should be indicated. • Specify the indicator for each item wanted to be monitored. • It may requires In-Depth interview, if decision to investigate causes is taken.

  10. Types of Surveillance Passive • Inexpensive, provider-initiated • Good for monitoring large numbers of typical health events • Under-reporting is a problem Active • More expensive, Health Department-initiated • Good for detecting small numbers of unusual health events • Enhanced • Rapid reporting and communication between surveillance agencies and stakeholders • Best for detecting outbreaks and potentially severe public health problems

  11. Data collection • Routine reporting system Hospitals, health centers, health facilities, CHW. Advantages: Inexpensive efficient. Standardized., Disadvantages: Incomplete Busy doctors & nurses

  12. New and complex disease entities must also be monitored… • New syndromes may emerge that present in an atypical manner • Syndromic surveillance uses health-related data that precede diagnosis and signal a sufficient probability of a case or an outbreak to warrant further public health response

  13. Example of Passive Surveillance • Day 1- feels fine • Day 2- headaches, fever - buys Tylenol • Day 3- develops cough - calls nurse hotline • Day 4- Sees private doctor – dx with “flu” • Day 5- Worsens - calls ambulance seen in ED • Day 6- Admitted - “pneumonia” • Day 7- Critically ill - ICU • Day 8- Expires - “respiratory failure” • Case enters surveillance system through an EDC

  14. Example of Syndromic Surveillance • Day 1- feels fine • Day 2- headaches, fever - buys Tylenol • Day 3- develops cough - calls nurse hotline • Day 4- Sees private doctor - dx “flu” • Day 5- Worsens - calls ambulance - seen in ED • Day 6- Admitted - “pneumonia” • Day 7- Critically ill - ICU • Day 8- Expires - “respiratory failure” • Case is under immediate investigation by the LHD because of the pre-diagnostic information gathered Pharmaceutical Sales Nurse’s Hotline Managed Care Org Absenteeism records Ambulance Dispatch (EMS) ED Logs

  15. 2-Sentnel reporting system Selected health units Advantages: More consistent pictures. Motivated. Disadvantages: Not representative Changed with surved population

  16. 3-Surveys and special studies Broad estimate. Measure reliability. Relieve health care workers. Disadvantages: Large sample size. Expensive

  17. 4-Case and outbreak investigations On occasion. Used as a next step

  18. Data collection procedures • Operational definition • Instruments Registers Questionnaires Case investigation form • Pre-test the instrument

  19. Data collection • Training • Supervision • Quality control • Reporting

  20. Analyze the data • Summary tables. • Disease charts. • Maps. • Rates & ratios • More analysis for pattern and causes

  21. Investigate causation • Case and outbreak investigations. • Verbal autopsy.

  22. Develop an action plan • What? • Who? • When? • Where? • How? • How? • Outline resources.

  23. Prepare and present reports • Review objectives. • Review tables, graphs & maps. • Add short narrative to explain findings. • Describe action plan. • Disseminate the report

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