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Overview of Public Health Surveillance

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Title: Overview of Public Health Surveillance


1
Overview of Public Health Surveillance
  • Epidemiology Program Office
  • Centers for Disease Control and Prevention

2
Public Health Approach
Implementation How do you do it?
Intervention Evaluation What works?
Problem
Response
3
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.

4
Public Health Surveillance
  • Systematic, ongoing
  • Collection
  • Analysis
  • Interpretation
  • Dissemination
  • Link to public health practice

5
Purposes of Public Health Surveillance
  • Assess public health status
  • Define public health priorities
  • Evaluate programs
  • Stimulate research

6
Core Public Health Functions
  • Assessment
  • Policy development
  • Assurance

7
Surveillance
  • Information for Action

8
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

9
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

10
SHIGELLOSIS Reported cases per 100,000
population, by year, United States, 1972-2002
Source CDC. Summary of notifiable diseases.
2002.
11
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

12
HEPATITIS A Reported cases per 100,000
population, United States and U.S. territories,
2002
Source CDC. Summary of notifiable diseases.
2002.
13
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

14
TOXIC-SHOCK SYNDROME Reported cases, by
quarter, United States, 1987-2002
Source CDC. Summary of notifiable diseases.
2002.
15
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

16
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.
17
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

18
MEASLES Reported cases, by year, United States,
1967-2002
Source CDC. Summary of notifiable diseases.
2002.
19
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.
20
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

21
POLIOMYELITIS, PARALYTIC, VACCINE
ASSOCIATED Reported cases by year, United States,
1972-2002
Source CDC. Summary of notifiable diseases.
2002.
22
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

23
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.
24
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
26
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

27
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
28
Obesity
United States, 1987-1998
29
Physical Activity
Georgia 1998
Source BRFSS 1998
30
Causal Pathway of Disease or Disability
  • Environment (pre-exposure)
  • Hazard/agent
  • Behavior/risk factor
  • Exposure
  • Pre-symptomatic phase
  • Apparent disease
  • Death

31
Selected Sources of Data
  • Environmental monitoring systems
  • Animals/vectors
  • Individuals
  • Laboratories
  • Medical records
  • Administrative records
  • Police records
  • Birth/death certificates

32
Data Sources and Methods for Surveillance
  • Notifiable diseases
  • Laboratory specimens
  • Vital records
  • Sentinel surveillance
  • Registries
  • Surveys
  • Administrative data systems
  • Other data sources

33
Data Sources/Methods
  • Notifiable diseases
  • Laboratory specimens
  • Vital records
  • Sentinel surveillance
  • Registries
  • Surveys
  • Administrative data systems
  • Other data sources

34
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

35
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)

36
MUMPS Reported cases per 100,000 population, by
year, United States, 1977-2002
Source CDC. Summary of notifiable diseases.
2002.
37
MEASLES Reported cases, by year, United States,
1967-2002
Source CDC. Summary of notifiable diseases.
2002.
38
Passive vs. Active Surveillance
  • Passive
  • - Provider-initiated
  • Active
  • - Health Department-initiated

39
Data Sources
  • Notifiable diseases
  • Laboratory specimens
  • Vital records
  • Sentinel surveillance
  • Registries
  • Surveys
  • Administrative data systems
  • Other data sources

40
SALMONELLOSIS Reported cases per 100,000
population, by year, United States, 1972-2002
Source CDC. Summary of notifiable diseases.
2002.
41
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.
42
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
43
Data Sources
  • Notifiable diseases
  • Laboratory specimens
  • Vital records
  • Sentinel surveillance
  • Registries
  • Surveys
  • Administrative data systems
  • Other data sources

44
Use of NCHS Data Systems for Surveillance
  • Vital Statistics
  • National Infant Mortality Surveillance (NIMS)
  • Linked
  • birth records
  • death records

45
Data Sources
  • Notifiable diseases
  • Laboratory specimens
  • Vital records
  • Sentinel surveillance
  • Registries
  • Surveys
  • Administrative data systems
  • Other data sources

46
Sentinel Surveillance
  • Monitoring of key health events through sentinel
  • Sites
  • Events
  • Providers
  • Vectors/animals

47
SENSOR
  • Sentinel
  • Event
  • Notification
  • System for
  • Occupational
  • Risks

48
Lead PoisoningMichigan, 1990
49
Confirmed Work-Related Asthma PatientsBy
Industry Type 1988-1998Michigan
4
6
16
Manufacturing n960
Construction n36
3
Services n215
71
Trade N47
Miscellaneous N76
50
Data Sources
  • Notifiable diseases
  • Laboratory specimens
  • Vital records
  • Sentinel surveillance
  • Registries
  • Surveys
  • Administrative data systems
  • Other data sources

51
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
52
Birth Defects Monitoring Programs
  • Vital records
  • Hospital discharge summaries
  • Hospital records (active abstraction)

53
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
54
Data Sources
  • Notifiable diseases
  • Laboratory specimens
  • Vital records
  • Sentinel surveillance
  • Registries
  • Surveys
  • Administrative data systems
  • Other data sources

55
Physical Inactivity
United States, 1998
56
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

57
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
58
Cesarean Deliveries United States, 1970-1992
Percentage
Year
Source National Hospital Discharge Survey (NHDS)
59
Data Sources
  • Notifiable diseases
  • Laboratory specimens
  • Vital records
  • Sentinel surveillance
  • Registries
  • Surveys
  • Administrative data systems
  • Other data sources

60
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
61
Data Sources
  • Notifiable diseases
  • Laboratory specimens
  • Vital records
  • Sentinel surveillance
  • Registries
  • Surveys
  • Administrative data systems
  • Other data sources

62
Other Data Useful for Surveillance
  • Vaccine Adverse Event Reporting System
  • CDC Drug Service
  • Miscellaneous

63
Information Loop of Public Health Surveillance
64
Overview of Public Health Surveillance
  • Epidemiology Program Office
  • Centers for Disease Control and Prevention
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