Surveillance in Emergencies European Diploma Course in Disaster Medicine Arona, Italy 27 April, 2004 Eric K. Noji, M.D., M.P.H. Senior Policy Advisor for Medical Readiness Department of Homeland Security Washington, DC

Disaster Epidemiology Assessment and Surveillance Assessment and Surveillance Injury and disease profiles Injury and disease profiles Research methodologies Research methodologies Disaster management Disaster management Vulnerability and hazard assessment Vulnerability and hazard assessment

Priority Public Health Interventions Surveillance and Health Information Systems Surveillance and Health Information Systems Water and Sanitation Water and Sanitation Communicable Disease Control Communicable Disease Control Immunization Immunization Nutrition Nutrition

Rapid Needs Assessment The collection of subjective and objective information, limited in time, performed in acute situations, which requires immediate action to be taken to respond to the basic requirements of the affected population

Hand-held Screens of Tornado Assessment Forms

On the Hand Held - Acute Disease Survey Form

Forms-Handheld Process Overview Encrypted Traffic Internet Repository User Defines and Tests Questionnaire (Form) Via Web Interface 1 Handheld User Selects Forms & Downloads by direct wireless connection or via PC/cradle connection 2 Multiple Users Can Immediately Enter Data directly via Web Form 3 4 User can enter Data via Forms when Handheld is disconnected 5 Handheld Data & Forms are Synchronized the Next time device is connected

Objectives of Health Information Systems in Emergency Populations Establish health care priorities Establish health care priorities Follow trends and reassess priorities Follow trends and reassess priorities Detect and respond to epidemics Detect and respond to epidemics Evaluate program effectiveness Evaluate program effectiveness Ensure targeting of resources Ensure targeting of resources Evaluate quality of health care Evaluate quality of health care

Goal of CMR in Emergency Populations For < 5 years of age: Less than 2.0 per 10,000 per day For < 5 years of age: Less than 2.0 per 10,000 per day For > 5 years of age: Less than 1.0 per 10,000 per day For > 5 years of age: Less than 1.0 per 10,000 per day

Morbidity Assessment Necessary Information Diseases of public health importance Diseases of public health importance Measles Measles Diarrhea Diarrhea Acute Respiratory infections Acute Respiratory infections Injuries Injuries Malnutrition Malnutrition

Diseases of epidemic potential Diseases of epidemic potential Cholera Cholera Dysentery Dysentery Meningitis Meningitis Yellow fever Yellow fever

Program or process indicators Immunization coverage Immunization coverage Supplementary feeding attendance Supplementary feeding attendance Antenatal and postnatal clinic coverage Antenatal and postnatal clinic coverage ORS distribution ORS distribution Water consumation Water consumation Caloric intake Caloric intake Latrine coverage Latrine coverage

The Assessment Process Identify information needs and resources Identify information needs and resources Collect data Collect data Analyze and interpret Analyze and interpret Report conclusions Report conclusions Design/modify disaster response Design/modify disaster response Back to the beginning of assessment Back to the beginning of assessment Identify information needs and resources Identify information needs and resources