Title: Overview of Public Health Surveillance
1Overview of Public Health Surveillance
- Epidemiology Program Office
- Centers for Disease Control and Prevention
2Public Health Approach
Implementation How do you do it?
Intervention Evaluation What works?
Problem
Response
3Public 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.
4Public Health Surveillance
- Systematic, ongoing
- Collection
- Analysis
- Interpretation
- Dissemination
- Link to public health practice
5Purposes of Public Health Surveillance
- Assess public health status
- Define public health priorities
- Evaluate programs
- Stimulate research
6Core Public Health Functions
- Assessment
- Policy development
- Assurance
7Surveillance
8Uses 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
9Uses 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
10SHIGELLOSIS Reported cases per 100,000
population, by year, United States, 1972-2002
Source CDC. Summary of notifiable diseases.
2002.
11Uses 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
12HEPATITIS A Reported cases per 100,000
population, United States and U.S. territories,
2002
Source CDC. Summary of notifiable diseases.
2002.
13Uses 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
14TOXIC-SHOCK SYNDROME Reported cases, by
quarter, United States, 1987-2002
Source CDC. Summary of notifiable diseases.
2002.
15Uses 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
16BOTULISM, 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.
17Uses 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
18MEASLES Reported cases, by year, United States,
1967-2002
Source CDC. Summary of notifiable diseases.
2002.
19PERTUSSIS 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.
20Uses 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
21POLIOMYELITIS, PARALYTIC, VACCINE
ASSOCIATED Reported cases by year, United States,
1972-2002
Source CDC. Summary of notifiable diseases.
2002.
22Uses 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
23Trends 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.
24Uses 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
25Breast Cancer Screening
26Uses 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
27TUBERCULOSIS 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
28Obesity
United States, 1987-1998
29Physical Activity
Georgia 1998
Source BRFSS 1998
30Causal Pathway of Disease or Disability
- Environment (pre-exposure)
- Hazard/agent
- Behavior/risk factor
- Exposure
- Pre-symptomatic phase
- Apparent disease
- Death
31Selected Sources of Data
- Environmental monitoring systems
- Animals/vectors
- Individuals
- Laboratories
- Medical records
- Administrative records
- Police records
- Birth/death certificates
32Data Sources and Methods for Surveillance
- Notifiable diseases
- Laboratory specimens
- Vital records
- Sentinel surveillance
- Registries
- Surveys
- Administrative data systems
- Other data sources
33Data Sources/Methods
- Notifiable diseases
- Laboratory specimens
- Vital records
- Sentinel surveillance
- Registries
- Surveys
- Administrative data systems
- Other data sources
34Current 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
35National 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)
36MUMPS Reported cases per 100,000 population, by
year, United States, 1977-2002
Source CDC. Summary of notifiable diseases.
2002.
37MEASLES Reported cases, by year, United States,
1967-2002
Source CDC. Summary of notifiable diseases.
2002.
38Passive vs. Active Surveillance
- Passive
- - Provider-initiated
- Active
- - Health Department-initiated
39Data Sources
- Notifiable diseases
- Laboratory specimens
- Vital records
- Sentinel surveillance
- Registries
- Surveys
- Administrative data systems
- Other data sources
40SALMONELLOSIS Reported cases per 100,000
population, by year, United States, 1972-2002
Source CDC. Summary of notifiable diseases.
2002.
41SALMONELLA 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.
42Blood 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
43Data Sources
- Notifiable diseases
- Laboratory specimens
- Vital records
- Sentinel surveillance
- Registries
- Surveys
- Administrative data systems
- Other data sources
44Use of NCHS Data Systems for Surveillance
- Vital Statistics
- National Infant Mortality Surveillance (NIMS)
- Linked
- birth records
- death records
45Data Sources
- Notifiable diseases
- Laboratory specimens
- Vital records
- Sentinel surveillance
- Registries
- Surveys
- Administrative data systems
- Other data sources
46Sentinel Surveillance
- Monitoring of key health events through sentinel
- Sites
- Events
- Providers
- Vectors/animals
47SENSOR
- Sentinel
- Event
- Notification
- System for
- Occupational
- Risks
48Lead PoisoningMichigan, 1990
49Confirmed Work-Related Asthma PatientsBy
Industry Type 1988-1998Michigan
4
6
16
Manufacturing n960
Construction n36
3
Services n215
71
Trade N47
Miscellaneous N76
50Data Sources
- Notifiable diseases
- Laboratory specimens
- Vital records
- Sentinel surveillance
- Registries
- Surveys
- Administrative data systems
- Other data sources
51Lung 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
52Birth Defects Monitoring Programs
- Vital records
- Hospital discharge summaries
- Hospital records (active abstraction)
53Prevalence 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
54Data Sources
- Notifiable diseases
- Laboratory specimens
- Vital records
- Sentinel surveillance
- Registries
- Surveys
- Administrative data systems
- Other data sources
55Physical Inactivity
United States, 1998
56Use 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
57Median 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
58Cesarean Deliveries United States, 1970-1992
Percentage
Year
Source National Hospital Discharge Survey (NHDS)
59Data Sources
- Notifiable diseases
- Laboratory specimens
- Vital records
- Sentinel surveillance
- Registries
- Surveys
- Administrative data systems
- Other data sources
60Ectopic 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
61Data Sources
- Notifiable diseases
- Laboratory specimens
- Vital records
- Sentinel surveillance
- Registries
- Surveys
- Administrative data systems
- Other data sources
62Other Data Useful for Surveillance
- Vaccine Adverse Event Reporting System
- CDC Drug Service
- Miscellaneous
63Information Loop of Public Health Surveillance
64Overview of Public Health Surveillance
- Epidemiology Program Office
- Centers for Disease Control and Prevention