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Event based surveillance systems

Event based surveillance systems. Alicia Barrasa. Introductory course 2012 Lazareto, Menorca, Spain. Infectious diseases. Arise from many different pathogens: viruses, bacteria, parasites

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Event based surveillance systems

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  1. Event based surveillance systems Alicia Barrasa Introductory course 2012 Lazareto, Menorca, Spain

  2. Infectious diseases • Arise from many different pathogens: viruses, bacteria, parasites • Spread in many different species: humans, insects, domestic and wild animals, aquatic animals and sometimes breach barrier between animal and humans (70% of emerging infections arise from animal population) • Take many different routes of transmission: direct contact, vectors, food, environmental • Affect all populations in all regions of the world

  3. Legionnaire’s disease Cryptosporidiosis Multidrug resistant Salmonella E. coli O157 Shigellosis West Nile Virus BSE E.coli non-O157 E. coli O157 Human monkepox Malaria nvCJD Typhoid A(H1N1)v Rabies SARS Diphtheria West Nile Fever Lyme Borreliosis Reston Typhoid Influenza A (H5N1) Kyasanur f. Lassa fever Echinococcosis Nipah Virus Yellow fever Cholera O139 RVF/VHF Reston Virus Venezuelan equine encephalitis Buruli ulcer Dengue haemhorrhagic fever O’nyong-nyong fever Respiratory infection Ebola haemorrhagic fever Dengue haemhorrhagic fever Human monkeypox Cholera Ross River virus Hendra virus Cholera Shigellosis Epidemic Alert and Response (EAR), WHO Regional Office for Europe Emerging and Re-emerging infectious diseases

  4. Accidental and deliberate release of infectious agents • Increased research, biotechnology is widely available • Increased risk for accidental release (e.g. SARS 2004 from laboratory) • World tensions remain and the deliberate release of infectious agents is no longer a remote threat.

  5. International Health Regulation 1374 Venice Quarantine for Plague 1851 Paris 1st International Sanitary Conference 1947 Geneva WHO Epidemiological Information Service 1951 Geneva International Sanitary Regulations 1969 Geneva International Health Regulations 2004 Regional consultations Nov 2004 Geneva Intergovernmental Working Group meeting Feb 2005 Geneva Intergovernmental Working Group meeting May 2005 Geneva Revised IHR, World Health Assembly adopted

  6. 4 diseases that always have to be notified polio (wild type virus), smallpox, human influenza caused by a novel virus, SARS. Diseases that always lead to the use of the algorithm : cholera, pneumonique plague, yellow fever, VHF (Ebola, Lassa, Marburg), WNF, meningitis, others *Q1: seriousgraves repercussions for public health? Q2: unusual or unexpected? Q3: risk of international spread? Q4: risk of travel or traffic restrictions? Insufficient information : re-evaluate IHR Decision Instrument

  7. IHR Decision Instrument

  8. International Health Regulation - 2005 To decide on need for notification any public health event can be assessed by the criteria • Is the public health impact of the event serious? • Is the event unusual or unexpected? • Is there a significant risk of international spread? • Is there a significant risk of international travel or travel restrictions ? • Surveillance • Response Obligation to establish core capacities:

  9. Epidemic Intelligence • Definition • The systematic collection and collation of information from a variety of sources, usually in real-time, which is then verified and analysed and, if necessary, activates response • Objective • to speed up detection of potential health threats and allow timely response

  10. Epidemic Intelligence - ECDC • Identify, assess and communicate current and emerging communicable disease threats • Establish procedures for the identification of emerging health threats in cooperation with MS • Inform EC and MS about emerging health threats requiring their immediate attention • Communication on emerging health threats, including to the public

  11. Surveillance is Information for action

  12. Epidemic Intelligence • Indicator-based surveillance • Event-based surveillance “Surveillance” systems • Event monitoring Data Events CollectAnalyseInterpret Screen/collectFilterValidate Signal Investigate Assess Public health Alert Response

  13. Indicator based Surveillance Surveillance systems • Ongoing and systematic • Collection and analysis of data • Interpretation and dissemination of results related to health events of interest • For action • Describe diseases • Outbreak detection • Monitor changes /interventions • Provide evidence for policy making • Generate hypothesis

  14. Event based Surveillance • Organized and rapid capture of information about events that are a potential risk to public health: • Events related to the occurrence to the disease in humans (clusters, unusual patterns, unexpected deaths…) • Events related to potential exposures (diseases in animals, contaminated food or water, environmental hazards…) • Need confirmation

  15. Indicator vs event based

  16. Indicator vs event based

  17. Indicator vs event based

  18. Epidemic Intelligence • Indicator-based surveillance • Event-based surveillance “Surveillance” systems • Event monitoring Data Events CollectAnalyseInterpret Screen/collectFilterValidate Signal Assess Investigate Public health Alert Response

  19. Epidemic Intelligence - ECDC

  20. The process of Epidemic Intelligence • Screening/collecting • Filtering • Validating • Analysis • Assessment • Documentation • Communication

  21. Screening / Collecting: Monitoring known threats and detecting new threats by screening a virtually unlimited amount of information.

  22. web-based early warning systems Sophisticated applications able to gather, filter and classify web-based information for public health purposes

  23. Filtering: The objective of filtering is to decide which information detected through screening might be potential public health events of National, European or international concern. Early detection

  24. Validation: This is the process of confirming the accuracy and credibility of information received from non-official sources (unverified information). Early detection Identification of signals

  25. Analysis: Initial evaluation based on preliminary info available in terms of likelihood and of possible human public health impact Risk Assessment

  26. Documentation: Logging information and actions taken during the EI process from the beginning is a crucial action to analyse the ongoing situation and to trace back all the steps

  27. Communication: To public/media and to scientific community about findings and assessment of potential public health events detected and investigated

  28. Epidemic Intelligence - ECDC

  29. A small summary • Indicator and event based systems are tools for PH Surveillance • event based systems have already been successfully used • The challenge: confirmation of the events

  30. Epidemic Intelligence at ECDC • 24/7 Screening of news from different sources • Round table • Daily threat assessment • Daily & weekly reports • Communication • Risk assessment • Response to outbreaks

  31. … to know more … WHO. The revision of the International Health Regulations. Wkly Epidemiol Rec 1996; 71: 233-5 WHO. Revision of the International Health Regulations: progress report, January 1998. Wkly Epidemiol Rec 1998; 73: 17-9 Paquet C, Coulombier D, Kaiser R, Ciotti M. Epidemic intelligence: a new framework for strengthening disease surveillance in Europe. Euro Surveill. 2006;11(12):665 WHO. A guide to establishing event-based surveillance http://www.wpro.who.int/internet/resources.ashx/CSR/Publications/eventbasedsurv.pdf

  32. Thank you for your attention

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