1. The HPA and Communicable Disease Data SEPHIG – 19 th October 2005 Esther Kissling, HPA SE

2. Content What is the HPA and what does it do? The role of the regional services and local units A closer look at surveillance systems –Data that flows through the regional services –Data that flows to Colindale –Detailed data flows What data are available?

3. Health Protection Agency (HPA) The Health Protection Agency was established in 2003 (previously PHLS) Its role is to provide an integrated approach to protecting UK public health through the provision of support and advice to the NHS, local authorities, emergency services, other Arms Length Bodies, the Department of Health and the Devolved Administrations

4. Health Protection Agency (HPA) HPA divisions include: Centre for Infections (including specialist and reference labs) Centre for Emergency Preparedness and Response Centre for Radiation, Chemical and Environmental Hazards Local and Regional Services

5. HPA Regional Services Division 9 Regional Units England + 1 in Northern Ireland 18 regional epidemiologists Scientists, information officers, administrators and contract staff

6. Regional Services Functions Surveillance & epidemiology Advice & support to RDPH Advice & support to professionals in communicable disease control Support national surveillance Eyes & ears & arms & legs for CfI Contribute to regional and national policy development Support 24h response capability

7. Local Services Functions There are 4 HPUs in the SE The task of each HPU is to work directly with the NHS primary care trusts (PCTs), acute hospital trusts and local authorities in their area and agree with them how health protection should be delivered locally. Functions include: local disease surveillance laboratory services alert systems, investigation and management of the full range of health protection incidents and outbreaks ensuring local delivery and monitoring of national action plans for infectious diseases.

8. Focus on Surveillance Diseases/Organisms/Conditions Under Surveillance – Collected at Different Levels: Viral infections Bacterial infections Deep-seated fungal infections Protozoa Helminths Prions Vaccination coverage Adverse events (vaccination failure, significant chemical or radiation exposure, etc.) Syndromic surveillance via NHSdirect (e.g. difficulty breathing, rash, fever, etc.)

9. Surveillance in England: Health Protection at Different Levels Primary care trust (PCT) level: Adverse health event is (usually) encountered: Hospitals, general practitioner surgeries, laboratories Health protection Unit (HPU) - sector level: Often first port of call for incidents and outbreaks at PCT level Regional level: Most surveillance information flows via the regional level, where health information is collated, analyzed, disseminated, acted upon and passed on to national level National level: Regional data are collected, analyzed and responded to. Nationally collected data get passed down to region.

10. Surveillance Data Flow Region Colindale Adverse health event HPU Clinician Lab worker Proper officer at Local Authority

11. Surveillance Systems Where Information Flows From Regional Services to Colindale: Incidents and Outbreaks alert system Laboratory surveillance NOIDS (statutory to Colindale – voluntary and partial to region) MRSA C. diff/GRE Enhanced TB disease Enhanced Meningococcal disease Antenatal screening datas

12. Key Conditions That Flow Via Colindale to Region: Most STI/HIV data Listeria Botulism Legionnaire’s disease E. Coli 0157 vCJD Region is dependent on Colindale for interpretation, analysis and dissemination for these organisms/conditions.

13. Laboratory Communicable Disease Reports (CDR) Provides a mechanism for general Communicable Disease Surveillance A voluntary system Laboratory confirmed reports of key public health pathogens Reporting by the source laboratory of clinically and public health significant isolates, including: Campylobacter Salmonella Clostridium difficile Influenza Staphylococcus aureus Enterococcus spp Hepatitis A/B/C Chlamydia Trachomatis

14. CDR Laboratory Reports: How does it work? LabBase 2 NATIONAL Laboratory information management system (LIMS) LabLink+ (If compatable with the LIMS) CoSurv Lab Module Lab worker manually enters data CDR paper form LAB DISTRICT: LAs and HPUs CoSurv District Module REGION CoSurv Region Module Data entry officer manually enters data

15. How Are Lab Surveillance Data Used? Trend analysis at regional and national level Outbreak identification Assessment of interventions Early warning system: Exceedance reports (Exceedance reports use statistical methods to assess whether lab reports for a particular organism during the current week exceed an expected upper limit value)

16. Enhanced Meningococcal Disease Surveillance Enhanced scheme to ensure complete ascertainment of all cases CCDC fills in a return on a weekly (during peak season) or monthly (non-peak season) and posts or sends in encrypted form to region Data are entered on regional database and matched with corresponding reports from the Meningococcal Reference Unit (MRU) Unmatched cases are followed up If clusters in educational establishments are identified, 2 cluster forms are filled in at regional level, with consultation of the CCDC

17. Enhanced Meningococcal Disease Surveillance Data flow Suspected case CCDC Region MRU Database Cluster forms Colindale

18. Enhanced Meningococcal Disease Surveillance

19. What data are available? Data on various health events/organisms available on the website: http://www.hpa.org.uk – data are mainly available by region:http://www.hpa.org.uk

20. What data are available? Publications: –Fortnightly bulletin: Public health information for professionals – contains sensitive information and is not published on the main website –Quarterlies – TB, lab and Meningo are currently being revised –Annual – report available as hard copy and via email

21. What data are available? Data are available on request from region and local units Data are often available by SHA, PCT, age and sex Data are available from Lab, TB, Meningo, STI/HIV surveillance, etc.

22. Data restrictions Information needs to be disclosed with appropriate care Medical information is deemed as “sensitive personal data” by the Data Protection Act Sensitive personal data DPA 1998: –The racial or ethnic origin of the data subject –Their physical or mental health or condition –Their sexual life Particular care given with STIs and HIV

23. Data restrictions No named data are disclosed (unless authorised) No date of births or postcodes of patients are disclosed Small numbers are not disclosed (denominator and numerator data are looked at)

24. Summary Data collection Data processing Data dissemination Timely and Appropriate Public Health Action