Overview of Public Health Surveillance

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Overview of Public Health Surveillance

• Epidemiology Program Office
• Centers for Disease Control and Prevention

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Public Health Approach
Implementation How do you do it?
Intervention Evaluation What works?
Problem
Response
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Public Health Surveillance

• Ongoing, systematic collection, analysis, and
  interpretation of health-related data essential
  to the planning, implementation, and evaluation
  of public health practice, closely integrated
  with the timely dissemination of these data to
  those responsible for prevention and control.

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Public Health Surveillance

• Systematic, ongoing
• Collection
• Analysis
• Interpretation
• Dissemination
• Link to public health practice

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Purposes of Public Health Surveillance

• Assess public health status
• Define public health priorities
• Evaluate programs
• Stimulate research

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Core Public Health Functions

• Assessment
• Policy development
• Assurance

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Surveillance

• Information for Action

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Uses of Public Health Surveillance

• Estimate magnitude of the problem
• Determine geographic distribution of illness
• Portray the natural history of a disease
• Detect epidemics/define a problem
• Generate hypotheses, stimulate research
• Evaluate control measures
• Monitor changes in infectious agents
• Detect changes in health practices
• Facilitate planning

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Uses of Public Health Surveillance

• Estimate magnitude of the problem
• Determine geographic distribution of illness
• Portray the natural history of a disease
• Detect epidemics/define a problem
• Generate hypotheses, stimulate research
• Evaluate control measures
• Monitor changes in infectious agents
• Detect changes in health practices
• Facilitate planning

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SHIGELLOSIS Reported cases per 100,000
population, by year, United States, 1972-2002
Source CDC. Summary of notifiable diseases.
2002.
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Uses of Public Health Surveillance

• Estimate magnitude of the problem
• Determine geographic distribution of illness
• Portray the natural history of a disease
• Detect epidemics/define a problem
• Generate hypotheses, stimulate research
• Evaluate control measures
• Monitor changes in infectious agents
• Detect changes in health practices
• Facilitate planning

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HEPATITIS A Reported cases per 100,000
population, United States and U.S. territories,
2002
Source CDC. Summary of notifiable diseases.
2002.
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Uses of Public Health Surveillance

• Estimate magnitude of the problem
• Determine geographic distribution of illness
• Portray the natural history of a disease
• Detect epidemics/define a problem
• Generate hypotheses, stimulate research
• Evaluate control measures
• Monitor changes in infectious agents
• Detect changes in health practices
• Facilitate planning

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TOXIC-SHOCK SYNDROME Reported cases, by
quarter, United States, 1987-2002
Source CDC. Summary of notifiable diseases.
2002.
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Uses of Public Health Surveillance

• Estimate magnitude of the problem
• Determine geographic distribution of illness
• Portray the natural history of a disease
• Detect epidemics/define a problem
• Generate hypotheses, stimulate research
• Evaluate control measures
• Monitor changes in infectious agents
• Detect changes in health practices
• Facilitate planning

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BOTULISM, FOODBORNE Reported cases, by year,
United States, 1982-2002
Data from the annual survey of State
Epidemiologist and Directors of State Public
Health Laboratories..
Source CDC. Summary of notifiable diseases.
2002.
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Uses of Public Health Surveillance

• Estimate magnitude of the problem
• Determine geographic distribution of illness
• Portray the natural history of a disease
• Detect epidemics/define a problem
• Generate hypotheses, stimulate research
• Evaluate control measures
• Monitor changes in infectious agents
• Detect changes in health practices
• Facilitate planning

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MEASLES Reported cases, by year, United States,
1967-2002
Source CDC. Summary of notifiable diseases.
2002.
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PERTUSSIS Reported cases, by age group, United
States, 2002
Of 9,771 cases, 25 were reported with unknown
age.
Source CDC. Summary of notifiable diseases.
2002.
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Uses of Public Health Surveillance

• Estimate magnitude of the problem
• Determine geographic distribution of illness
• Portray the natural history of a disease
• Detect epidemics/define a problem
• Generate hypotheses, stimulate research
• Evaluate control measures
• Monitor changes in infectious agents
• Detect changes in health practices
• Facilitate planning

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POLIOMYELITIS, PARALYTIC, VACCINE
ASSOCIATED Reported cases by year, United States,
1972-2002
Source CDC. Summary of notifiable diseases.
2002.
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Uses of Public Health Surveillance

• Estimate magnitude of the problem
• Determine geographic distribution of illness
• Portray the natural history of a disease
• Detect epidemics/define a problem
• Generate hypotheses, stimulate research
• Evaluate control measures
• Monitor changes in infectious agents
• Detect changes in health practices
• Facilitate planning

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Trends in Plasmid-Mediated Resistance to
Penicillin and Tetracycline United States,
1988-1997
Percent
PPNG
TRNG
PPNG TRNG
Source Gonococcal Isolate Surveillance Project
(GISP)
Year
Note "PPNG" (penicillinase-producing ) and
"TRNG" (tetracycline-resistant) N. gonorrhoeae
refer to plasmid-mediated resistance to
penicillin and tetracycline, respectively.
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Uses of Public Health Surveillance

• Estimate magnitude of the problem
• Determine geographic distribution of illness
• Portray the natural history of a disease
• Detect epidemics/define a problem
• Generate hypotheses, stimulate research
• Evaluate control measures
• Monitor changes in infectious agents
• Detect changes in health practices
• Facilitate planning

25
Breast Cancer Screening
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Uses of Public Health Surveillance

• Estimate magnitude of the problem
• Determine geographic distribution of illness
• Portray the natural history of a disease
• Detect epidemics/define a problem
• Generate hypotheses, stimulate research
• Evaluate control measures
• Monitor changes in infectious agents
• Detect changes in health practices
• Facilitate planning

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TUBERCULOSIS Reported cases among U.S.-born and
foreign-born persons, by year, United States,
1990-2002
In 2002, place of birth was unknown for 120
case-patients.
Source CDC. Summary of notifiable diseases. 2002
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Obesity
United States, 1987-1998
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Physical Activity
Georgia 1998
Source BRFSS 1998
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Causal Pathway of Disease or Disability

• Environment (pre-exposure)
• Hazard/agent
• Behavior/risk factor
• Exposure
• Pre-symptomatic phase
• Apparent disease
• Death

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Selected Sources of Data

• Environmental monitoring systems
• Animals/vectors
• Individuals
• Laboratories
• Medical records
• Administrative records
• Police records
• Birth/death certificates

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Data Sources and Methods for Surveillance

• Notifiable diseases
• Laboratory specimens
• Vital records
• Sentinel surveillance
• Registries
• Surveys
• Administrative data systems
• Other data sources

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Data Sources/Methods

• Notifiable diseases
• Laboratory specimens
• Vital records
• Sentinel surveillance
• Registries
• Surveys
• Administrative data systems
• Other data sources

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Current Status National Notifiable Diseases
Surveillance System (NNDSS)

• CSTE/CDC collaboration
• List revised at annual CSTE meeting
• Voluntary reporting by states to CDC
• Reporting mandated at state level
• Reportable diseases vary by state

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National Notifiable Disease Surveillance

• Reporting mandated by state law/regulation
• Health care providers, laboratories report to
  local HD (county)
• County HD submits reports to State
• Reports transmitted to CDC primarily through
  National Electronic Telecommunications System for
  Surveillance (NETSS)

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MUMPS Reported cases per 100,000 population, by
year, United States, 1977-2002
Source CDC. Summary of notifiable diseases.
2002.
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MEASLES Reported cases, by year, United States,
1967-2002
Source CDC. Summary of notifiable diseases.
2002.
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Passive vs. Active Surveillance

• Passive
• - Provider-initiated
• Active
• - Health Department-initiated

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Data Sources

• Notifiable diseases
• Laboratory specimens
• Vital records
• Sentinel surveillance
• Registries
• Surveys
• Administrative data systems
• Other data sources

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SALMONELLOSIS Reported cases per 100,000
population, by year, United States, 1972-2002
Source CDC. Summary of notifiable diseases.
2002.
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SALMONELLA Reported isolates, by serotype and
year, United States, 1976-2001
Data from Public Health Laboratory Information
System (PHLIS).
Source CDC. Summary of notifiable diseases.
2001.
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Blood Lead Measurements 1975-1981
110
18
Predicted blood lead
100
Lead used in gasoline (thousands of tons)
16
90
Mean blood lead levels ? g/dl
80
Gasoline lead
14
70
Observed blood lead
12
60
50
10
40
30
8
1975
1976
1977
1978
1979
1980
1981
Year
Source Pirkle et al JAMA 272284-91, 1994
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Data Sources

• Notifiable diseases
• Laboratory specimens
• Vital records
• Sentinel surveillance
• Registries
• Surveys
• Administrative data systems
• Other data sources

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Use of NCHS Data Systems for Surveillance

• Vital Statistics
• National Infant Mortality Surveillance (NIMS)
• Linked
• birth records
• death records

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Data Sources

• Notifiable diseases
• Laboratory specimens
• Vital records
• Sentinel surveillance
• Registries
• Surveys
• Administrative data systems
• Other data sources

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Sentinel Surveillance

• Monitoring of key health events through sentinel
• Sites
• Events
• Providers
• Vectors/animals

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SENSOR

• Sentinel
• Event
• Notification
• System for
• Occupational
• Risks

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Lead PoisoningMichigan, 1990
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Confirmed Work-Related Asthma PatientsBy
Industry Type 1988-1998Michigan
4
6
16
Manufacturing n960
Construction n36
3
Services n215
71
Trade N47
Miscellaneous N76
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Data Sources

• Notifiable diseases
• Laboratory specimens
• Vital records
• Sentinel surveillance
• Registries
• Surveys
• Administrative data systems
• Other data sources

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Lung and Bronchus Cancer (Invasive) United
States, 1973-1994 SEER Incidence and U.S.
Mortality
Year
Source Cancer Statistics Review, 1973-1994 Rate
is age-adjusted to 1970 U.S. Population
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Birth Defects Monitoring Programs

• Vital records
• Hospital discharge summaries
• Hospital records (active abstraction)

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Prevalence of Anencephaly and Spina
BifidaMetropolitan Atlanta Congenital Defects
Program, 1968-2000
25
Prenatally Diagnosed Cases
20
Hospital-based. LB SB Babies
15
Before Fortification
Rate per 10,000
After Fortification
10

5
0
68
71
74
77
80
83
86
89
92
95
98
Year of Birth
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Data Sources

• Notifiable diseases
• Laboratory specimens
• Vital records
• Sentinel surveillance
• Registries
• Surveys
• Administrative data systems
• Other data sources

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Physical Inactivity
United States, 1998
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Use of NCHS Data Systems for Surveillance

• Population-based surveys
• National Health Interview Survey
• National Health and Nutrition Examination Survey
• Provider-based surveys
• National Hospital Discharge Survey
• National Ambulatory Medical Care Survey

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Median Serum Folate, NHANES III and 1999,
Nonpregnant Women, 15-44 years
4.8
14.5
50
40
Post fortification
30
Percentile
20
10
Prefortification
0
0
10
20
30
40
Serum Folate, ng/ml
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Cesarean Deliveries United States, 1970-1992
Percentage
Year
Source National Hospital Discharge Survey (NHDS)
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Data Sources

• Notifiable diseases
• Laboratory specimens
• Vital records
• Sentinel surveillance
• Registries
• Surveys
• Administrative data systems
• Other data sources

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Ectopic PregnanciesUnited States 1980-1996
100000
80000
Number of
60000
Ectopic
40000
20000
Pregnancies in women 15-44
0
80
82
84
86
88
90
92
94
96
Year
Source National Hospital Discharge Survey, NCHS,
CDC
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Data Sources

• Notifiable diseases
• Laboratory specimens
• Vital records
• Sentinel surveillance
• Registries
• Surveys
• Administrative data systems
• Other data sources

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Other Data Useful for Surveillance

• Vaccine Adverse Event Reporting System
• CDC Drug Service
• Miscellaneous

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Information Loop of Public Health Surveillance
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Overview of Public Health Surveillance

• Epidemiology Program Office
• Centers for Disease Control and Prevention