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

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Presentation on theme: "Overview of Uses for Public Health Surveillance Daniel M. Sosin, M.D., M.P.H. Division of Public Health Surveillance and Informatics Epidemiology Program."— Presentation transcript:

1 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

2 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.

3 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

4 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

5 Shigellosis 1968-1998 0 0 5 5 10 15 Year 1968 1973 1978 1983 1988 1993 1998 Reported cases per 100,000 population Source: CDC. Summary of notifiable diseases. 1998.

6 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

7 TOXIC SHOCK SYNDROME (TSS) United States, 1983-1998 TOXIC SHOCK SYNDROME (TSS) United States, 1983-1998 *Includes cases meeting the CDC definition for confirmed and probable cases for staphylococcal TSS. 1983 1984 1985 198619871988 1989 19901991 1992 199319941995199619971998 National Center for Infectious Diseases (NCID) data* National Electronic Telecommunications System for Surveillance (NETSS) data 0 2020 4040 6060 8080 10 0 12 0 14 0 16 0 Year (Quarter) Reported cases

8 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

9 Rate of Hepatitis A United States, 1998 < 5.0 5.0–9.9 10.0–19.9 >20.0 NA NYC DC PR VI GUAM AM SAMOA CNMI Source: CDC. Summary of notifiable diseases. 1998.

10 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

11 Botulism (Foodborne) United States, 1978-1998 *Data from survey of state epidemiologists and directors of state public health laboratories. Not yet available for 1998. *Data from survey of state epidemiologists and directors of state public health laboratories. Not yet available for 1998. 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 0 0 10 20 30 40 50 60 70 80 90 100 110 Year 1978 1983 1988 1993 1998 Reported cases Source: CDC. Summary of notifiable diseases. 1998.

12 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

13 Year Reported cases (thousands) Vaccine licensed 0 0 50 100 150 200 250 300 350 400 450 500 1963 1968 1973 1978 1983 1988 1993 1998 MEASLES — by year, United States, 1983– 1998 0 0 5 5 10 15 20 25 30 Year 1983 1988 1993 1998 Reported Cases (Thousands) Source: CDC. Summary of notifiable diseases. 1998. MEASLES (Rubeola) United States, 1963-1998

14 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

15 Poliomyelitis (Paralytic) NOTE: Inactivated vaccine was licensed in 1955. Oral vaccine was licensed in 1961. Year 0 0 5 5 10 15 20 25 30 35 40 45 50 55 60 1968 1973 1978 1983 1988 1993 1998 Reported cases Source: CDC. Summary of notifiable diseases. 1998. Rate/100,000 Population Year Inactivated Vaccine Oral Vaccine United States, 1968-1998

16 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

17 Trends in Plasmid-Mediated Resistance to Penicillin and Tetracycline United States, 1988-1997 Source: Gonococcal Isolate Surveillance Project (GISP) Percent 0 2 4 6 8 10 12 1988198919901991199219931994199519961997 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

18 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

19 Breast Cancer Screening

20 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

21 Foreign-born Source: CDC. Summary of notifiable diseases. 1998. Tuberculosis United States, 1986-1998 (U.S.- and foreign-born persons)

22 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

23 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

24 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

25 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

26 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

27 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

28 Resources www.cdc.gov/cic www.cdc.gov/epo/dphsi/phs.htm www.cdc.gov/epo/dphsi/phs/syndromic.htm dsosin@cdc.gov

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