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• “ Ultimately a single
element, a single addition to
the strategy of the
[eradication] program was
responsible [for its success]
.. that change was the
incorpotation of the principle
of surveillance”
D. A. Henendersen
Smallpox Eradication](https://image.slidesharecdn.com/surveillanceyv-240417064608-8fab4071/75/Surveillance-system-type-steps-in-planning-a-system-ppt-24-2048.jpg)
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Surveillance system type, steps in planning a system.ppt
- 1.
- 2. Premises of Reinventing Government •What gets measured gets done. • If you don't measure results, you can't tell success from failure. • If you can't see success, you can't reward it. • If you can't reward success, you're probably rewarding failure. • If you can't see success, you can't learn from it. • If you can't recognize failure, you can't correct it. • If you can demonstrate success, you can win public support.
- 3. SCHEME OF PRESENTATION •DEFINITION • TYPES • ELEMENTS • USES • STEPS IN PLG • ATTRIBUTES • EVALUATION
- 4. Surveillance “Surveillance, when appliedto a disease, means the continued watchfulness over the distribution, and trends of the incidence, through the systematic collection, consolidation and evaluation of morbidity, mortality and other health relevant data, as well as regular dissemination of interpretations to all who have contributed and to all those who are in a position to take action”. “information for action”. (Suggested by Alexander Langmuir and adopted by WHO in 1968)
- 5. Surveillance Vs Monitoring Surveillance Isthe ongoing systematic collection, collation, analysis and interpretation of data; and the dissemination of information to those who need to know in order that action may be taken • Concerns mostly general populations • Req professional Analysis & judgement Monitoring Refers to ongoing measurements of health services or a health programme with a view to ‘evaluate’ the particular programme / service or intervention, with constant adjustment of performance in relation to the results. • Applies to specific target gps (e.g. Vaccinated infants) • Can be carried out by technicians & Instrumentation • A part of surveillance
- 6. HISTORY • Late 1600s:von Leibnitz – mortality report analysis • 1680s- John Graunt: ‘Natural and Political Observations made Upon Bills of Mortality’ – defines disease specific death counts and rates • 1700s: Vital Stats used in Europe • 1741--Rhode Island--Tavern keepers reporting contagious diseases • 1840-1850: Chadwik – demonstrates relationship between poverty, env conditions and diseases • Late 1800s: Notifiable disease concept • 1850--Lemuel Shattuck--Report of the Massachusetts Sanitary Commission.
- 7. HISTORY • 1925: AllUS states - national morbidity reporting • 1935: First national health Survey – US • 1943: cancer registry – Denmark • 1940s: Case definition concept implemented • 1955: Active surv for polio • 1963: Langmuir – modern concept of Surv in Pub Hlth • 1960s: Network of ‘Sentinel’ GPs in UK; Surv used for Small Pox eradication • 1980s: IT in Surv – Decentralization, Dissemination • 1990: Internet – transit & report; Inc concern reg Privacy, confidentiality • 2001: Syndromic Surveillance - Anthrax
- 8. PURPOSE • Three genericpurposes – Identify public health problems – May stimulate public health intervention – May suggest hypotheses for research
- 9. Types of Surveillance •Passive surveillance – a system in which data generated without solicitation, intervention or contact by the health agency carrying out the surveillance. Other agencies initiate reporting. • Active surveillance – the organization conducting surveillance initiates procedures to obtain reports
- 10. Types of Surveillancecontd. • Enhanced passive surveillance – active follow up of cases to pursue other possible causes/cases – e.g. contact tracing in STD • Sentinel Surveillance - Surveillance system in which reports are obtained from certain facilities or populations
- 11. 11 Syndromic Surveillance • Syndromicsurveillance systems face inherent trade- offs (among sensitivity, and the number of false positives) timeliness, that limit their effectiveness • The benefits of any Syndromic surveillance system will depend on how effectively it is integrated into the public health system • Syndromic surveillance is useful: (suspected outbreaks and during outbreaks; depends on case definitions)
- 12. 12 Surveillance of Diseasevs. Persons • Surveillance of Disease: “ The continuing scrutiny of all aspects of occurrence and spread of disease that are pertinent to its effective control” • Surveillance of Persons: “ The continuing scrutiny of disease contacts, high risk groups in order to promote prompt recognition of infection or illness”
- 13. 13 Surveillance various levels •Individual Surveillance • Local population Surveillance • National Population Surveillance • International Surveillance
- 14. 14 • Immidiate • Epidemics •Newly emerging health problems • Changes in health practices • Changes in antibiotic resistance • Annual • Estimating magnitude of health problems • Assessing control activities • setting research priorities • Testing hypothesis • Facilitate plg • Archival • Describing natural history of a disease • Facilitate epidemiolgic research • Validating use of preliminary data • Documenting dist of spread SURVEILLANCE ACCORDING TO TIMELINESS
- 15. 15 • Natural andman-made disasters (emergencies) • During Special events of mass gatherings – Pilgrims to Makkah – Olympics • Laboratory-based surveillance: – Emerging pathogens – Antimicrobial resistance • Infection control • Behavioural risk factors • Others Special Surveillance Programs
- 16. 16 Exposed Clinical specimen Disease +ve specimen Infected Seekmedical attention Reported Laboratory-based surveillance Syndromic Surveillance Serological surveys We see only reported cases
- 17. Simplified Diagram ofSurveillance for a Health Problem
- 18. Information Loops • Asurveillance system is an information loop or cycle that involves: – healthcare providers – public health agencies – the public # 1-4-5
- 19. Flow of Surveillance Data Collection Analysisand Interpretation Dissemination, Utilisation Collation # 1-4-6
- 20. •Surveillance is systematicongoing collection, collation, and analysis of data, and the timely dissemination of information to those who need to know so that action can be taken •A survey is a one data collection episode •Registries are not for immediate action •Health Management Information Systems (HMIS) for annual reports Surveillance, surveys, registries and HMIS:
- 21. 21 • Registers arearchival health information • Surveillance is dynamic as compared with surveys: Interplay between epidemiologic studies and control activities • Surveillance is not mere: – Reporting – Monitoring – Data collection Note the Differences:
- 22. ELEMENTS OF SURVEILLANCE •Cycle of Surveillance • Confidentiality • Incentives to Participation • Surveillance Ethics • legitimate desire to protect privacy • Stigma
- 23. Avian Flu, EU $500m 19961997 1998 1999 2000 2001 2002 2003 $50bn $40bn $30bn $20bn $10bn Estimated costs BSE, UK $10-13bn Foot&Mouth Disease Taiwan, $5-8bn 1992 1993 1994 1995 Foot-and-Mouth Disease UK $30bn Avian Flu Asia, US, Canada $10bn 2004 BSE, US $3.5bn BSE, Canada $1.5bn Lyme disease US, $2.5bn SARS China, Hong Kong, Singapore, Canada,… $50bn+ Nipah, Malaysia $350-400m Swine Flu, Netherlands $2.3bn BSE, Japan 1.5bn Economic Impact of Recent Epidemics
- 24. 24 • “ Ultimatelya single element, a single addition to the strategy of the [eradication] program was responsible [for its success] .. that change was the incorpotation of the principle of surveillance” D. A. Henendersen Smallpox Eradication
- 25. Rationale for DiseaseSurveillance The disease is of public health importance • Caution! – Is it worth the effort (money, human resources)? – Are relevant data easily available? – Can action be taken?
- 26. Objectives of surveillance DESCRIPTIVEEPID OF HEALTH PROBLEMS • Monitoring trends (Time): Measles in US • Person Distribution: Groups at highest risk of disease Insight into etiologies, modes of spread Guide Prev activities before etiology known e.g. Surv AIDS – sexual, drug and medical history
- 27. Objectives of surveillance DESCRIPTIVEEPID OF HEALTH PROBLEMS • Epidemic / outbreak detection and prediction: Syndromic surveillance – bioterrorism related epidemics non specific syndromes (resp, GI..), other measures (purchase of drugs, absenteeism..) • Place Distribution: Maps
- 28. Objectives of surveillance DESCRIPTIVEEPID OF HEALTH PROBLEMS • Estimate magnitude of health problem • Changes in health practices – e.g. Caesarian deliveries • Distribution and spread in time & Place • Natural history
- 29. Objectives of surveillance LINKSTO SERVICES Integral part of delivery of prev & therapeutic services Receipt of a case report triggers specific response e.g. TB case – to cure, minimize transmission, prevent resistance, contact identification LINKS TO RESEARCH Insufficient details for probing in-depth hypothesis, Hypothesis generating e.g. studies assoc TSS with tampon
- 30. Objectives of surveillance EVALUATIONOF INTERVENTIONS Trends, Rates Monitor programme performance e.g. TSS cases fell after removal of tampon from market. PLANNING & PROJECTIONS Planners need future demands for health services Epidemiological models Applying current disease rates to future population projectons
- 31. Objectives of surveillance EDUCATION& POLICY Alert physicians to community health problems Inform policy makers about prevention or care resources requirement
- 32. Uses of PublicHealth 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
- 33. Uses of PublicHealth 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
- 34. Shigellosis 1968-1998 0 5 10 15 Year 1968 1973 197 8 19831988 1993 1998 Reported cases per 100,000 population Source: CDC. Summary of notifiable diseases. 1998.
- 35. Uses of PublicHealth 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
- 36. TOXIC SHOCK SYNDROME(TSS) United States, 1983-1998 *Includes cases meeting the CDC definition for confirmed and probable cases for staphylococcal TSS. 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 National Center for Infectious Diseases (NCID) data* National Electronic Telecommunications System for Surveillance (NETSS) data 0 2 0 4 0 6 0 8 0 10 0 12 0 14 0 16 0 Year (Quarter) Reported cases
- 37. Evolution of anEpidemic Estimated AIDS incidence* through 2000, United States *Estimated from data reported to CDC through June 2001, adjusted for reporting delays. 0 10000 20000 30000 40000 50000 60000 70000 80000 90000 1 9 8 2 1 9 8 4 1 9 8 6 1 9 8 8 1 9 9 0 1 9 9 2 1 9 9 4 1 9 9 6 1 9 9 8 2 0 0 0 Year of Diagnostics Number of Cases Serologic assay for HIV antibody available HIV identified AIDS case definition expanded AZT shown to reduce risk of perinatal transmission Protease inhibitors licensed for use in US 100,000 AIDS cases reported to CDC as of July 1989. 500,000 AIDS cases reported to CDC as of October 1995 An estimated 798,500 AIDS cases diagnosed through 2000 Use of HAART becomes widespread. AZT monotherapy becomes available AIDS case definition modified First AIDS case definition published
- 38. Uses of PublicHealth 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
- 39. Rate of HepatitisA United States, 1998 < 5.0 5.0–9.9 10.0–19.9 >20.0 NA NA NA NYC DC PR VI GUAM AM SAMOA CNMI Source: CDC. Summary of notifiable diseases. 1998.
- 40. Uses of PublicHealth 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
- 41. Botulism (Foodborne) United States,1978-1998 *Data from survey of state epidemiologists and directors of state public health laboratories. Not yet available for 1998. Outbreak caused by potato salad, NM Outbreak caused by sautéed onions, IL Outbreak caused by fermented fish/sea products, AK Outbreak caused by baked potatoes, TX Laboratory-confirmed cases* NETSS data 0 10 20 30 40 50 60 70 80 90 100 110 Year 1978 1983 1988 1993 1998 Reported cases Source: CDC. Summary of notifiable diseases. 1998.
- 42. Uses of PublicHealth 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
- 43. Year Reported cases (thousands) Vaccine licensed 0 50 100 150 200 250 300 350 400 450 500 1963 19681973 1978 1983 1988 1993 1998 MEASLES — by year, United States, 1983– 1998 0 5 10 15 20 25 30 Year 1983 1988 1993 1998 Reported Cases (Thousands) Source: CDC. Summary of notifiable diseases. 1998. MEASLES (Rubeola) United States, 1963-1998
- 44. Uses of PublicHealth 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
- 45. Poliomyelitis (Paralytic) NOTE: Inactivatedvaccine was licensed in 1955. Oral vaccine was licensed in 1961. Year 0 5 10 15 20 25 30 35 40 45 50 55 60 1968 1973 1978 1983 1988 1993 1998 Reported cases Source: CDC. Summary of notifiable diseases. 1998. Rate/100,000 Population Year Inactivated Vaccine Oral Vaccine 0.001 0.01 0.1 1 10 100 1000 1951 1956 1961 1966 1971 1976 1981 1986 1991 1996 United States, 1968-1998
- 46. Uses of PublicHealth 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
- 47. Trends in Plasmid-MediatedResistance to Penicillin and Tetracycline United States, 1988-1997 Source: Gonococcal Isolate Surveillance Project (GISP) Percent 0 2 4 6 8 10 12 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 PPNG TRNG PPNG & TRNG Note: "PPNG" (penicillinase-producing ) and "TRNG" (tetracycline-resistant) N. gonorrhoeae refer to plasmid- mediated resistance to penicillin and tetracycline, respectively. Year
- 48. Uses of PublicHealth 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
- 49.
- 50. Uses of PublicHealth 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
- 51. Foreign-born Year U.S.-born 1986 1987 19881989 1990 1991 1992 1993 1994 1995 1996 1997 1998 0 4,000 8,000 12,000 16,000 20,000 Reported cases Tuberculosis United States, 1986-1998 (U.S.- and foreign-born persons)
- 52. Uses of PublicHealth 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
- 53. 53 Early Warning (EWARN): Animportant Component of Surveillance Systems • Rumour verification • EWARNs Detect clusters in time, place or persons Change in trend • Programme monitoring Programme indicators • Surveillance system monitoring Operation indicators Support indicators Output indicators Requiring immediate investigation Requiring programme adjustment Requiring system improvement Requiring verification
- 54. Early Warning Signals Clusteringof cases or deaths in time & /or space Unusual increase in cases/ deaths • Ac. hemorrhagic fever • Ac. fever with altered sensorium/ renal involvement/ painful lymph node/ unknown aetiology • Severe dehydration following diarrhoea in patients > 5 year of age • Ac. flaccid paralysis in a child
- 55. Early Warning Signals- II 2 or more linked cases • Even a single case of epidemic prone diseases in tribal/poorly accessible area • Unusual isolate in laboratory • Shift in age distribution of a disease • High vector density in local area • Natural disasters
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- 58. Surveillance for OutbreakDetection • 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
- 59. Surveillance for OutbreakDetection: 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
- 60. Surveillance for OutbreakDetection: 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
- 61. Surveillance for OutbreakDetection: 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
- 62. Surveillance functions Core function •Reporting • Detection • Investigation & confirmation • Analysis & interpretation • Action / response Support function • Training • Supervision • Resources • Standards / guidelines
- 63. Steps in planninga surveillance system Decide if justifiable Establish objectives Specify organization and structure Develop case definition Specify the details of collection of information Organization and procedures of data analysis Making scientific interpretations Ensure proper feedback Evaluation Assure use of analysis and interpretation
- 64. • Frequency ofoccurrence • Severity of condition – sequel, disabilities • Cost of surveillance • Preventability of condition • Communicability of condition – potential for an outbreak • Public interest – public perception and concern • International requirements. Determine Priority/Importance Steps in planning
- 65. Ability to prevent,control, or treat the health problem • preventability and • control measures and treatment. Capacity of health system to implement control measures for the health problem — • speed of response, • economics, • availability of resources, and • what surveillance of this event requires. Determine Priority/Importance contd.. Steps in planning
- 66. Case definition • Clinicalversus laboratory – Balance competing needs of • Sensitivity • Specificity and • feasibility • Level of case definition (suspected, probable, confirmed) Example Influenza: – Suspected: A person with sudden onset of fever > 39C, respiratory symptoms, myalgias, headaches – Probable: A suspected case , epidemiologically linked to laboratory-confirmed case – Confirmed: A suspected case with virus isolation or direct antigen detection Steps in planning
- 67. Collection of information Datasource • Disease notifications and Notifiable diseases • vital statistics • Vital record linkages • Health reports • Hospital records/ health centers • Laboratory • Disease registries • Health surveys • Studies on animals & vectors Steps in planning
- 68. Collection of information Datasource contd • Member of the public, media • Socio-demographic & environmental data • Co-operating Physicians • Absenteeism from workplace & School • Administrative actions • Financial transactions – Sales of goods & services – Taxation • Legal actions • Law and regulations Steps in planning
- 69. 72 Collection of information •Method of data collection –Active Surveillance: –Passive Surveillance: –Sentinel surveillance –Volunteer providers –Special surveillance team Steps in planning
- 70. 73 Collection of information •Forms used – simple & brief • What time/ place of diagnosis entered • Frequency of reporting – Daily ( cholera, food poisoning) –Weekly ( Malaria) –Monthly ( HIV) • Method of transmission of reports • Central collection of data Steps in planning
- 71. TYPES OF NOTIFICATIONS 1.Disease or hazard-specific notifications a. Communicable diseases i. World Health Organization: International health regulations require reporting of Smallpox, Poliomyelitis ,Human influenza, SARS etc. ii. National: United States and Canada specify diseases that require notification by all states and provinces, respectively iii. Provincial, state, or subnational: for example, coccidiomycosis in California b. Chemical and physical hazards in the environment i. Childhood lead poisoning ii. Occupational hazards iii. Firearm-related injury iv. Consumer product-related injury Adapted from: Koo D, Wingo P, Rothwell C. Health Statistics from Notifications, Registration Systems, and Registries.
- 72. TYPES OF NOTIFICATIONScontd. 2. Notifications related to treatment administration a. Adverse effect of drugs or medical products b. Adverse effect from vaccines 3. Notifications related to persons at risk a. Elevated blood lead among adults b. Elevated blood lead among children Adapted from: Koo D, Wingo P, Rothwell C. Health Statistics from Notifications, Registration Systems, and Registries. In: Friedman D, Parrish RG, Hunter E (editors). Health Statistics: Shaping Policy and Practice to Improve the Population’s Health. New York: Oxford University Press; 2005, p. 82.
- 73. TYPESOF REGISTRIES 1. Vitalevent registration a. Birth registration b. Marriage and divorce registration c. Death registration 2. Registries used in preventive medicine a. Immunization registries b. Registries of persons at risk for selected conditions c. Registries of persons positive for genetic conditions 3. Disease-specific registries a. Blind registries b. Birth defects registries c. Cancer registries d. Psychiatric case registries e. Ischemic heart disease registries Adapted from: Koo D, Wingo P, Rothwell C. Health Statistics from Notifications, Registration Systems, and Registries. In: Friedman D, Parrish RG, Hunter E (editors). Health Statistics: Shaping Policy and Practice to Improve the Population’s Health. New York: Oxford University Press; 2005, p. 91
- 74. TYPESOF REGISTRIES contd. 4.Treatment registries a. Radiotherapy registries b. Follow-up registries for detection of iatrogenic thyroid disease 5. After-treatment registries a. Handicapped children b. Disabled persons 6. Registries of persons at risk or exposed a. Children at high risk for developing a health problem b. Occupational hazards registries c. Medical hazards registries d. Older persons or chronically ill registries e. Atomic bomb survivors (Japan) f. World Trade Center survivors (New York City) 7. Skills and resources registries 8. Prospective research studies
- 75.
- 76. 79 • Weekly? Appropriatemost times • Monthly? Less sensitive • Quarterly? At national level • Daily? – Daily reporting could be cumbersome – Daily reporting may be required during emergencies, disasters • Avoid inconsistencies in case definitions • Reporting suspected vs. confirmed cases Frequency of Reporting Diseases
- 77. Analysis, Interpretation &Presentation of Surveillance data • Attribution of Time • Attribution of Place; use of GIS • Attribution of persons • Detection of change in trends • Assessing Completeness of surveillance Capture-Recapture Steps in planning
- 78. Analysis, Interpretation &Presentation of Surveillance data Inferential statistics : Analytic procedures usually are based on comparing the current incidence against the “Upper and Lower Control Limits” Steps in planning
- 79. Analysis, Interpretation &Presentation of Surveillance data • Smoothing • Protection of confidentiality Presentation • Wide range of Users • Mode of presentation – intended audience Steps in planning
- 80. Common causes ofartifactual changes • Changes in local reporting procedures or policies (e.g., a change from passive to active surveillance). • Changes in case definition (e.g., AIDS in 1993). • Increased health-seeking behavior (e.g., media publicity prompts persons with symptoms to seek medical care). • Increase in diagnosis. • New laboratory test or diagnostic procedure.
- 81. Common causes ofartifactual changes contd. • Increased physician awareness of the condition, or a new physician is in town. • Increase in reporting (i.e., improved awareness of requirement to report). • Outbreak of similar disease, misdiagnosed as disease of interest. • Laboratory error. • Batch reporting in which reports from previous periods are held and reported all at once during another reporting period (e.g. reporting all cases received during December and the 1st week of January during the second week of
- 82. Dissemination mechanism Directly toall who need to know • Press release to the public • Reports, bulletins • Others Steps in planning
- 83. Assure use ofanalysis and interpretation Control measures – rapid response – case management – prevention programme (immunisation) Planning/ policy making – epidemic preparedness – policy modification – prediction and future planning Feedback to the system Steps in planning
- 84. Periodically evaluate/review the surveillancesystem For • Completeness • Accuracy • Process and • Adequacy To See Whether the case definitions need a change? Problems in the timely and accurate reporting and how can it be improved? Defects and reorient the methodology. Steps in planning
- 85. Public Health Surveillance SystemAttributes • Simplicity • Flexibility • Data Quality • Acceptability • Sensitivity • Predictive Value Positive • Representativeness • Timeliness • Stability
- 86. Check List forAssessing an Established Surveillance System 1. Broad goals & objectives 2. Adequate Staffing Adequate training 3. The diseases under surveillance Sensitivity & specificity of the diagnostic criteria and case – definitions Are facilities for diagnosing available?
- 87. Check List forAssessing an Established Surveillance System 4. The sources of information Are the persons proficient in recording the case definitions? Feasibility of forms used by the peripheral workers 5. Timely reporting 6. How much is the under - or over - reporting? 7. Maintenance of manual and automated files
- 88. Check List forAssessing an Established Surveillance System 8. The time lag between receipt of reports and generation of analysed feedback reports. 9. Are the reports generated simple and presentable ? Are they forwarded to all concerned 10. Has the information been actually used 11. Is the surveillance system periodically evaluated
- 89. The International HealthRegulations (IHR): A global framework • Legally-binding global agreement to protect public health • The international commitment for shared responsibilities and collective defence against disease spread • Collective effort based on agreed rules Smallpox, 1950s
- 90. International public healthsecurity is the goal Ensuring maximum public health security while minimizing interference with international transport and trade Come into force on 15 June 2007* Legally binding for WHO and the world’s countries that have agreed to play by the same rules to secure international health. Legally binding upon 194 States Parties around the world (including all WHO Member States)
- 91. From control ofborders to (also) containment at source From diseases list to all threats From preset measures to adapted and real time response IHR(2005): a paradigm shift
- 92. Strategic framework • Communicationand exchange of information • Coordination • Joint cross-boarder surveillance and outbreak investigation • Resources sharing and mobilization • Standardization and sharing surveillance tools • Laboratory network • Preparedness and response to outbreaks • Capacity building • Social mobilization • Monitoring and evaluation
- 93. 99 • Vary fromone country to another – Differences within countries – Changes over time • Adding one single disease to the list could cost a lot: Money, time, avoidable confusion • Variables collected should be indicators of potential or arising problems rather than identifying risk factors • Report only confirmed cases? Reportable Diseases
- 94. Past Approaches • Duplicationof efforts and resources Delays in reporting and identification of outbreaks Lack of dissemination and feedback to the local level Lack of integration of training and surveillance activities # 1-4-13
- 95. Common Problems withPast Surveillance Systems, Cont. Limited evaluation of programmes Inadequate involvement of laboratories Incomplete reporting and lack of supervisory support # 1-4-14