MORBIDITY DATA: REGISTRIES AND SURVEILLANCE

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MORBIDITY DATA REGISTRIES AND SURVEILLANCE

• Nigel Paneth

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WHAT SHOULD BE UNDER SURVEILLANCE?

• Health events (diseases or exposures) with
• HIGH FREQUENCY
• HIGH LEVEL OF SEVERITY
• HIGH LEVEL OF TRANSMISSIBILITY
• HIGH ECONOMIC COST
• HIGH POTENTIAL FOR PREVENTION

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KINDS OF SURVEILLANCE

•   1. VITAL DATA
•   2. REGISTRIES
• 3. NOTIFIABLE DISEASES
•   4. SENTINEL HEALTH CARE SETTINGS
•   5. SENTINEL EVENTS
•   6. SPECIAL SURVEYS

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Steps In Setting Up Surveillance

• 1. DETERMINE WHAT KIND OF SURVEILLANCE IS BEST
  FOR THE CONDITION OF INTEREST.  
• 2. DEFINE CASENESS. 
• 3. DEFINE THE POPULATION UNDER SURVEILLANCE. 

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• 4. DEVELOP DATA COLLECTION INSTRUMENTS. 
• 5. DECIDE WHO THE INFORMATION GOES TO.
• 6. MONITOR THE SYSTEM
•   FOR VALIDITY
•   FOR USEFULNESS

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Key Attributes Of Surveillance Programs

• 1. Nature of the event
•  
• 2. Population under surveillance
•  
• 3. Nature of the surveillance process
•  
• 4. Continuity of the monitoring
•  
• 5. To whom do the reports go?

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1. NATURE OF THE EVENT UNDER SURVEILLANCE

• EXAMPLE
• a. Death Vital data
• b. Disease/condition
•   based on screening newborn
• 
  genetic screening results
•   definitive diagnosis SEER cancer
  registries

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• 1. NATURE OF THE EVENT UNDER SURVEILLANCE.
  (contd)
• EXAMPLE
• c. exposure vaccine registries behavioral
  risk factors
•  
• d. diagnostic test mammography surveillance
•  
• e. animal disease bovine TB surveillance,
  fox bat rabies

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• 2. NATURE OF THE DENOMINATOR POPULATION
•  
• A. EVERYONE IN A DEFINED SETTING
• EXAMPLE
• a. Universal Reportable diseases, vi
  tal data
•  
• b. Everyone in a SEER geographic
  area Registries or areas

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• 2. NATURE OF THE DENOMINATOR POPULATION
  (CONTD)  
• EXAMPLE
• c. Selected sub-sets sentinel of the
  population practices for influenza
•  
• d. Special samples of Behavioral the
  populations Risk factors, Health
  Interview Survey

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• 2. NATURE OF THE DENOMINATOR POPULATION
  (CONTD)  
• B. CONDITIONAL ON A CHARACTERISTIC
•   EXAMPLE
• a. requires exposure A-bomb survivors,
  DES daughters
•  
• b. requires special LBW babies
  cohort membership

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• 2. NATURE OF THE DENOMINATOR POPULATION
  (CONTD)  
• C. NO DENOMINATOR NEEDED
•   EXAMPLE
• SENTINEL EVENTS
• (highly likely to maternal be
  preventable) death to diphtheria

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• 3. NATURE OF THE SURVEILLANCE PROCESS.
• EXAMPLE
• a. Active Reyes
• (we call them) syndrome
•  
• b. Passive most registries
• (they call us)

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• 4. CONTINUITY OF THE SURVEILLANCE
•   EXAMPLE
• a. once-only community survey
•  
• b. continuous registries monitoring

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• 5. TO WHOM REPORTED?
•   EXAMPLE
• a. state as per state law
•  
• b. national 49 reportable diseases
•  
• c. international plague, yellow fever,
  cholera, etc.