1. Causal Pathway of Disease or Disability Environment (pre-exposure) Hazard/agent Behavior/risk factor Exposure Pre-symptomatic phase Apparent disease Death

2. Selected Sources of Data Environmental monitoring systems Animals/vectors Individuals Laboratories Medical records Administrative records Police records Birth/death certificates

3. Data Sources and Methods for Surveillance Notifiable diseases Laboratory specimens Vital records Sentinel surveillance Registries Surveys Administrative data systems Other data sources

4. Data Sources/Methods Notifiable diseases Laboratory specimens Vital records Sentinel surveillance Registries Surveys Administrative data systems Other data sources

5. Current Status: National Notifiable Diseases Surveillance System (NNDSS) CSTE/CDC collaboration List revised at annual CSTE meeting Voluntary reporting by states to CDC Reporting mandated at state level Reportable diseases vary by state

6. National Notifiable Disease Surveillance Reporting mandated by state law/regulation Health care providers, laboratories report to local HD (county) County HD submits reports to State Reports transmitted to CDC primarily through National Electronic Telecommunications System for Surveillance (NETSS)

7. 0 0 5 5 10 15 20 25 30 35 40 45 50 Year 1973 1978 1983 1988 1993 1998 Reported Cases per 100,000 Population MUMPS — by year, United States, 1983–1998 0 1 2 3 4 5 6 7 Year 1983198819931998 Reported Cases per 100,000 Population Reported Cases per 100,000 Population MUMPS United States 1973-1998

8. 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) MEASLES (Rubeola) United States, 1963-1998 20 10

9. Passive vs. Active Surveillance Passive - Provider-initiated Active - Health Department-initiated

10. Data Sources Notifiable diseases Laboratory specimens Vital records Sentinel surveillance Registries Surveys Administrative data systems Other data sources

11. Salmonellosis (excluding Typhoid Fever) United States, 1967-1997 Outbreak caused by contaminated pasteurized milk, IL Year

12. Salmonella—serotypes of isolates United States, 1973-1998 Year 1973 1978 1983 1988 1993 1998 Enteritidis Typhimurium Other Unknown Outbreak caused by contaminated pasteurized milk, IL 0 0 3,000 6,000 9,000 12,00 0 15,00 0 18,00 0 21,00 0 24,00 0 27,00 0 30,00 0 Reported isolates Enteritidis Typhimurium

13. Blood Lead Measurements 1975-1981 197519761977197819791980 1981 30 40 50 60 70 80 90 100 110 8 10 12 14 16 18 Year Predicted blood lead Gasoline lead Observed blood lead Lead used in gasoline (thousan ds of tons) Mean blood lead levels  g/dl

14. Data Sources Notifiable diseases Laboratory specimens Vital records Sentinel surveillance Registries Surveys Administrative data systems Other data sources

15. Use of NCHS Data Systems for Surveillance Vital Statistics  National Infant Mortality Surveillance (NIMS)  Linked:  birth records  death records

16. Data Sources Notifiable diseases Laboratory specimens Vital records Sentinel surveillance Registries Surveys Administrative data systems Other data sources

17. Sentinel Surveillance Monitoring of key health events through sentinel:  Sites  Events  Providers  Vectors/animals

18. SENSOR Sentinel Event Notification System for Occupational Risks

19. Lead Poisoning Michigan, 1990 NONE 1-25 26-100 100+

20. Confirmed Work-Related Asthma Patients By Industry Type: 1988-1998 Michigan 3% 16% 4% 71% 6% Manufacturing: n=960 Construction: n=36 Services: n=215 Trade: N=47 Miscellaneous: N=76

21. Data Sources Notifiable diseases Laboratory specimens Vital records Sentinel surveillance Registries Surveys Administrative data systems Other data sources

22. Year 73747576777879808181 8283848586878889909191 929394 Incidence Mortality 0 10 20 30 40 50 60 70 Number/100,000 Lung and Bronchus Cancer (Invasive) United States, 1973-1994 SEER Incidence and U.S. Mortality

23. Birth Defects Monitoring Programs Vital records Hospital discharge summaries Hospital records (active abstraction)

24. 0 5 10 15 20 25 6871747780838689929598 Year of Birth Rate per 10,000 Prenatally Diagnosed Cases Hospital-based. LB & SB Babies Before Fortification After Fortifcation Prevalence of Anencephaly and Spina Bifida Metropolitan Atlanta Congenital Defects Program, 1968-2000

25. Data Sources Notifiable diseases Laboratory specimens Vital records Sentinel surveillance Registries Surveys Administrative data systems Other data sources

26. Physical Inactivity United States, 1998

27. Use of NCHS Data Systems for Surveillance Population-based surveys  National Health Interview Survey  National Health and Nutrition Examination Survey Provider-based surveys  National Hospital Discharge Survey  National Ambulatory Medical Care Survey

28. 0 10 20 30 40 50 010203040 Serum Folate, ng/ml Percentile Median Serum Folate, NHANES III and 1999, Nonpregnant Women, 15-44 years Post fortification Prefortification 4.814.5

29. Cesarean Deliveries United States, 1970-1992 0 5 10 15 20 25 30 1970 1972 1974 1976 197819801982 1984 19861988 1990 1992 Year Percentage

30. Data Sources Notifiable diseases Laboratory specimens Vital records Sentinel surveillance Registries Surveys Administrative data systems Other data sources

31. Ectopic Pregnancies United States 1980-1996 0 20000 40000 60000 80000 100000 808284868890929496 Year Number of Ectopic Pregnancies in women 15-44

32. Data Sources Notifiable diseases Laboratory specimens Vital records Sentinel surveillance Registries Surveys Administrative data systems Other data sources

33. Other Data Useful for Surveillance Vaccine Adverse Event Reporting System CDC Drug Service Miscellaneous

34. Summaries, Interpretations, Recommendations Reports Health Agencies Health Care Providers Public Analysis Information Loop of Public Health Surveillance