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9/22/00 ANN JOLLY 2
Definition “Ongoing systematic collection, analysis,
and interpretation of health data essential to the planning, implementation, and evaluation of public health practice, as well as the timely dissemination to those who need to know”
• Centers for Disease Control. Comprehensive plan for epidemiologic surveillance. 1986
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Public Health Law - Communicable Disease Control
Reporting and surveillance Investigation as to source Examination Treatment Isolation/quarantine
with or without judge’s permission order with or without a warning of an order
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Reporting Legislation requires the report
name, address, locating and demographics laboratory data clinical treatment source, contact data
Reportable by; Laboratory Health professionals
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Case definition Defined by government
As part of regulations or Act includes disease of unusually high numbers Or disease with unusual manifestations ( high
fatality) Laboratory test component Clinical Or both Ad hoc
Take an inclusive list of 80-90% of first 3-5 presenting cases at least
Be aware that agent may change, and hosts may become immune.
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Surveillance & Management Ensure the case, and contacts are properly
managed Monitor the number of cases for unusual changes
risk, manifestation, affected population, geographic area
Consists of : collection compilation analysis dissemination
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Investigation/contact tracing Case is treated, educated and questioned
about possible exposures The names of the contacts or sources are
reported to public health officials Then the contacts/sources are located,
examined, treated and educated
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Public health data
Laboratory test
Physician report
Laboratory test
Physician report
Public Heath
DepartmentComputer or
card file
Public health nurse
Contact of case
Public Health
Department
Case
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Confidentiality
Disease reporting individual’s right to privacy is being
violated justification is that it benefits that person or protects the public health
Contact tracing/ partner notification Duty to warn
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Tasks1. Set objectives
Monitor geographic and temporal trends Investigate Prevent Monitor occurrence, without intervention
for health system planning Monitor for further study
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Tasks 2. Collect data
Disease case reports (notifications) Laboratory reports Death certificates Schools Sentinel surveillance sites Animal reports
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Tasks4. Organise data
Output aggregate data from reports by time place person
Calculate rates, confidence limits Tabulate, graph
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Tasks5. Analyse and interpret
Compare current data with past experience, in terms of;
Seasonality Space Error,
alpha or beta (statistical) lab error calculation data entry
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Tasks6. Disseminate
Regional Medical Officer of Health Provincial Epidemiologist Chief Medical Health Officer Infectious disease specialists Public health units Public health inspectors
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Tasks7. Hypothesis formation
Formulate i.e. waterborne in one municipality
Identify further data to substantiate Obtain data Organise Analyse and interpret Refute or prove hypothesis
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Tasks8. Recommend/implement control measures
Establish objectives for control barriers to infection at any point(s) in
host/agent/environment cycle Recommend control measures Implement control measures Evaluate and monitor control measures
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Tasks10. Evaluate surveillance system
Data sources timeliness accuracy completeness
Use and relevance of data Are surveillance objectives being met? Recommend and implement changes
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References
Teutsch, SM and Churchill, RE, eds. Principles and practice of public health surveillance. Oxford University Press, 1994
Morbidity and Mortality Weekly Report. Supplement, December 1992. Proceedings of the 1992 International Symposium on Public health surveillance. Vol 41.
Thacker SB, Berkelman RL. Public health surveillance in the United States. Epidemiologic Reviews 1988;120:164-188