Overview of Uses for Public Health Surveillance Daniel M. Sosin, M.D., M.P.H. Division of Public Health Surveillance and Informatics Epidemiology Program Office

Public Health Surveillance Ongoing, systematic collection, analysis, and interpretation of health- related data and dissemination for use in the planning, implementation, and evaluation of public health practice.

Uses of Public Health Surveillance Estimate magnitude of the problem Portray the natural history of a disease Determine distribution and spread of illness Detect outbreaks Generate hypotheses, stimulate research Evaluate control and prevention measures Monitor changes in infectious agents Detect changes in health practices Facilitate planning

Uses of Public Health Surveillance Estimate magnitude of the problem Portray the natural history of a disease Determine distribution and spread of illness Detect outbreaks Generate hypotheses, stimulate research Evaluate control measures Monitor changes in infectious agents Detect changes in health practices Facilitate planning

Shigellosis Year Reported cases per 100,000 population Source: CDC. Summary of notifiable diseases

Uses of Public Health Surveillance Estimate magnitude of the problem Portray the natural history of a disease Determine distribution and spread of illness Detect outbreaks Generate hypotheses, stimulate research Evaluate control measures Monitor changes in infectious agents Detect changes in health practices Facilitate planning

TOXIC SHOCK SYNDROME (TSS) United States, TOXIC SHOCK SYNDROME (TSS) United States, *Includes cases meeting the CDC definition for confirmed and probable cases for staphylococcal TSS National Center for Infectious Diseases (NCID) data* National Electronic Telecommunications System for Surveillance (NETSS) data Year (Quarter) Reported cases

Uses of Public Health Surveillance Estimate magnitude of the problem Portray the natural history of a disease Determine distribution and spread of illness Detect outbreaks Generate hypotheses, stimulate research Evaluate control measures Monitor changes in infectious agents Detect changes in health practices Facilitate planning

Rate of Hepatitis A United States, 1998 < – –19.9 >20.0 NA NYC DC PR VI GUAM AM SAMOA CNMI Source: CDC. Summary of notifiable diseases

Uses of Public Health Surveillance Estimate magnitude of the problem Portray the natural history of a disease Determine distribution and spread of illness Detect outbreaks Generate hypotheses, stimulate research Evaluate control measures Monitor changes in infectious agents Detect changes in health practices Facilitate planning

Botulism (Foodborne) United States, *Data from survey of state epidemiologists and directors of state public health laboratories. Not yet available for *Data from survey of state epidemiologists and directors of state public health laboratories. Not yet available for Outbreak caused by potato salad, NM Outbreak caused by sautéed onions, IL Outbreak caused by fermented fish/sea products, AK Outbreak caused by baked potatoes, TX Laboratory-confirmed cases* NETSS data Year Reported cases Source: CDC. Summary of notifiable diseases

Uses of Public Health Surveillance Estimate magnitude of the problem Portray the natural history of a disease Determine distribution and spread of illness Detect outbreaks Generate hypotheses, stimulate research Evaluate control measures Monitor changes in infectious agents Detect changes in health practices Facilitate planning

Year Reported cases (thousands) Vaccine licensed MEASLES — by year, United States, 1983– Year Reported Cases (Thousands) Source: CDC. Summary of notifiable diseases MEASLES (Rubeola) United States,

Uses of Public Health Surveillance Estimate magnitude of the problem Portray the natural history of a disease Determine distribution and spread of illness Detect outbreaks Generate hypotheses, stimulate research Evaluate control measures Monitor changes in infectious agents Detect changes in health practices Facilitate planning

Poliomyelitis (Paralytic) NOTE: Inactivated vaccine was licensed in Oral vaccine was licensed in Year Reported cases Source: CDC. Summary of notifiable diseases Rate/100,000 Population Year Inactivated Vaccine Oral Vaccine United States,

Uses of Public Health Surveillance Estimate magnitude of the problem Portray the natural history of a disease Determine distribution and spread of illness Detect outbreaks Generate hypotheses, stimulate research Evaluate control measures Monitor changes in infectious agents Detect changes in health practices Facilitate planning

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

Uses of Public Health Surveillance Estimate magnitude of the problem Portray the natural history of a disease Determine distribution and spread of illness Detect outbreaks Generate hypotheses, stimulate research Evaluate control measures Monitor changes in infectious agents Detect changes in health practices Facilitate planning

Breast Cancer Screening

Uses of Public Health Surveillance Estimate magnitude of the problem Portray the natural history of a disease Determine distribution and spread of illness Detect outbreaks Generate hypotheses, stimulate research Evaluate control measures Monitor changes in infectious agents Detect changes in health practices Facilitate planning

Foreign-born Source: CDC. Summary of notifiable diseases Tuberculosis United States, (U.S.- and foreign-born persons)

Uses of Public Health Surveillance Estimate magnitude of the problem Portray the natural history of a disease Determine distribution and spread of illness Detect outbreaks Generate hypotheses, stimulate research Evaluate control and prevention measures Monitor changes in infectious agents Detect changes in health practices Facilitate planning

Surveillance for Outbreak Detection Convergence of technology, volumes of electronic data, and new priority for early detection Increase timeliness and completeness of routine data Capture nontraditional data that signify a condition before a diagnosis is made Analytic methods to detect smaller signals

Surveillance for Outbreak Detection: Experience Laboratory specificity to detect clusters Sentinel systems with resources to monitor and investigate Syndrome surveillance where outbreaks are substantial and predictable Case reports trigger outbreak investigation

Surveillance for Outbreak Detection: Exploration Enhanced reporting from clinical sites (ED, EMS, 911, offices) Health care transaction warehouses (pharmacy, patient encounters, lab orders) Novel data sources (retail sales, veterinary encounters, environmental indicators, absenteeism) Signal detection methods

Surveillance for Outbreak Detection: Reality Human “technology” is key  Single case detection depends on clinical acumen and reporting relationships  Epidemiologic judgment in evaluating volumes of data  Follow-up of system signals Tolerance for false alarms will vary

Surveillance Research Needs Achieving the National Electronic Disease Surveillance System (NEDSS) architecture Data fusion (linkage) New data sources Case definitions (automation/validation) Geographic Information System (GIS) indices Forecasting Evaluation and quality control

Resources