Overview of Public Health Surveillance
Denise Koo, MD, MPH Epidemiology Program Office Centers for Disease Control and Prevention
Public Health Approach
Risk Factor Identification: What is the cause?
Intervention Evaluation: What works?
Implementation: How do you do it?
Problem
Surveillance: What is the problem?
Response
Public Health Surveillance
Ongoing, systematic collection, analysis, and interpretation of health-related data essential to the planning, implementation, and evaluation of public health practice, closely integrated with the timely dissemination of these data to those responsible for prevention and control.
Public Health Surveillance
Systematic, ongoing Collection Analysis Interpretation Dissemination Link to public health practice
Purposes of Public Health Surveillance
Assess public health status Define public health priorities Evaluate programs Stimulate research
Surveillance
Information for Action
Uses of Public Health Surveillance
Estimate magnitude of the problem Determine geographic distribution of illness Portray the natural history of a disease Detect epidemics/define a problem Generate hypotheses, stimulate research Evaluate control measures Monitor changes in infectious agents Detect changes in health practices Facilitate planning
Uses of Public Health Surveillance
Estimate magnitude of the problem Determine geographic distribution of illness Portray the natural history of a disease Detect epidemics/define a problem Generate hypotheses, stimulate research Evaluate control measures Monitor changes in infectious agents Detect changes in health practices Facilitate planning
15
United States, 1968-1998
Shigellosis
Reported Cases per 100,000 Population
10
5
0
1968 1973 1978 1983 1988 1993 1998
Year Source: CDC. Summary of notifiable diseases. 1998.
Uses of Public Health Surveillance
Estimate magnitude of the problem Determine geographic distribution of illness Portray the natural history of a disease Detect epidemics/define a problem 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
NYC DC
NA
PR VI GUAM
SAMOA
NAAM NA
CNMI
< 5.0
5.0–9.9 10.0–19.9 >20.0 Source: CDC. Summary of notifiable diseases. 1998.
Uses of Public Health Surveillance
Estimate magnitude of the problem Determine geographic distribution of illness Portray the natural history of a disease Detect epidemics/define a problem 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, 1983-1998
160
140
National Center for Infectious Diseases (NCID) data*
Reported Cases
120 100 80 60 40 20 0
National Electronic Telecommunications System for Surveillance (NETSS) data
Year (Quarter)
1984 1988 1994 1996 1986 1990 1992 1998 1983 1985 1991 1993 1995 1997 1987 1989
Uses of Public Health Surveillance
Estimate magnitude of the problem Determine geographic distribution of illness Portray the natural history of a disease Detect epidemics/define a problem Generate hypotheses, stimulate research Evaluate control measures Monitor changes in infectious agents Detect changes in health practices Facilitate planning
Botulism (Foodborne)
110
100
90 80 70
Reported Cases
United States, 1978-1998 Outbreak Outbreak caused Laboratorycaused by by sautéed confirmed cases* potato NETSS data onions, IL salad, NM Outbreak caused by Outbreak caused by fermented fish/sea baked potatoes, TX products, AK
60
50 40 30 20 10 0 1978
Year Source: CDC. Summary of notifiable diseases. 1998.
1983
1988
1993
1998
Uses of Public Health Surveillance
Estimate magnitude of the problem Determine geographic distribution of illness Portray the natural history of a disease Detect epidemics/define a problem Generate hypotheses, stimulate research Evaluate control measures Monitor changes in infectious agents Detect changes in health practices Facilitate planning
Reported Cases (Thousands)
500
450
United States, 1963-1998 Vaccine MEASLES — by year, United licensed States, 1983–1998
MEASLES (Rubeola)
350
Reported Cases (Thousands)
25 20 15 10 5 0
400
30
300 250 200
20 10
1988 1993 1998
150
100 50 0
1963 1968 1973
1983
Year
1978
Year
1983
1988
1993
1998
Pertussis (Whooping Cough)
2,400
United States, 1998
2,100
1,800
Reported Cases
1,500 1,200 900 600 300 0
<1
1–4
5–9
10–14 15–19 20–29 30–39 40–49 50–59 >60
Age Group (Years)
Uses of Public Health Surveillance
Estimate magnitude of the problem Determine geographic distribution of illness Portray the natural history of a disease Detect epidemics/define a problem Generate hypotheses, stimulate research Evaluate control measures Monitor changes in infectious agents Detect changes in health practices Facilitate planning
Poliomyelitis (Paralytic)
60 55 50 45
United States, 1968-1998
Rate/100,000 Population
1000
100 10
Inactivated Vaccine Oral Vaccine
Reported Cases
40 35 30 25 20 15 10 5 0
1968
1
0.1 0.01 0.001
1956 19611966 19711976 19811986 1991 1996 1951
Year
Year
1973
1978
1983
1988
1993
1998
Source: CDC. Summary of notifiable diseases. 1998.
Uses of Public Health Surveillance
Estimate magnitude of the problem Determine geographic distribution of illness Portray the natural history of a disease Detect epidemics/define a problem 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, 1988-1997
12
Percent
PPNG TRNG PPNG & TRNG
10
8
6 4 2 0
1988 1989 1990 1991 1992 1993 1994 1995 1996 1997
Source: Gonococcal Isolate Surveillance Project (GISP)
Year
Uses of Public Health Surveillance
Estimate magnitude of the problem Determine geographic distribution of illness Portray the natural history of a disease Detect epidemics/define a problem 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 Determine geographic distribution of illness Portray the natural history of a disease Detect epidemics/define a problem Generate hypotheses, stimulate research Evaluate control measures Monitor changes in infectious agents Detect changes in health practices Facilitate planning
20,0 00 16,0 00
United States, 1986-1998 (U.S.- and foreign-born persons)
Tuberculosis
U.S.born
Reported Cases
Foreignborn
12,0 00
8,00 0 4,00 0
0
Year
1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998
Obesity
United States, 1987-1998
Not available
< 10 %
…… ……. ……. 10%-15%
>15%
Physical Activity
Georgia 1998
PER CENT
Responses
YES Less than 15,00015,000$ 24,999$
NO 35,000$50,000> 49,999$
25,00034,999$
Source: BRFSS 1998