3051 Overview of Public Health Surveillance

Causal Pathway of Disease or Disability        Environment (pre-exposure) Hazard/agent Behavior/risk factor Exposure Pre-symptomatic phase Apparent disease Death Selected Sources of Data         Environmental monitoring systems Animals/vectors Individuals Laboratories Medical records Administrative records Police records Birth/death certificates Data Sources and Methods for Surveillance         Notifiable diseases Laboratory specimens Vital records Sentinel surveillance Registries Surveys Administrative data systems Other data sources Data Sources/Methods         Notifiable diseases Laboratory specimens Vital records Sentinel surveillance Registries Surveys Administrative data systems Other data sources 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 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) MUMPS Reported Cases per 100,000 Population 50 45 40 35 30 United States 1973-1998 7 6 5 4 3 2 1 0 1983 MUMPS — by year, United States, 1983–1998 25 20 15 10 5 0 1973 1978 Reported Cases per 100,000 Population 1988 1993 1998 Year 1983 1988 1993 1998 Year MEASLES (Rubeola) Reported Cases (Thousands) 500 450 United States, 1963-1998 Vaccine MEASLES — by year, United licensed States, 1983–1998 350 Reported Cases (Thousands) 25 20 400 30 300 250 200 150 100 50 0 1963 1968 1973 20 15 10 10 1988 1993 1998 5 0 1983 Year 1978 Year 1983 1988 1993 1998 Passive vs. Active Surveillance Passive - Provider-initiated  Active - Health Department-initiated  Data Sources         Notifiable diseases Laboratory specimens Vital records Sentinel surveillance Registries Surveys Administrative data systems Other data sources 30 (excluding Typhoid Fever) United States, 1967-1997 Outbreak caused by contaminated pasteurized milk, IL Salmonellosis Reported Cases per 100,000 Population 25 20 15 10 5 0 1967 1972 1977 1982 1987 1992 1997 Year Salmonella—serotypes of isolates 30,00 0 27,00 0 24,00 0 21,00 0 18,00 0 15,00 0 12,00 0 United States, 1973-1998 Outbreak caused Enteritidis Typhimurium by contaminated pasteurized milk, IL Unknown Reported isolates Other 9,000 6,000 3,000 0 Typhimurium Enteritidis 1973 1978 1983 1988 1993 Year 1998 Blood Lead Measurements 1975-1981 110 18 Lead used in gasoline (thousan ds of tons) 100 Predicted blood lead 16 90 80 70 Gasoline lead 60 50 40 30 Observed blood lead Mean blood 14 lead levels  g/dl 12 10 1975 1976 1977 Year 1978 1979 1980 8 1981 Data Sources         Notifiable diseases Laboratory specimens Vital records Sentinel surveillance Registries Surveys Administrative data systems Other data sources Use of NCHS Data Systems for Surveillance Vital Statistics  National Infant Mortality Surveillance (NIMS)  Linked:  birth records  death records Data Sources         Notifiable diseases Laboratory specimens Vital records Sentinel surveillance Registries Surveys Administrative data systems Other data sources Sentinel Surveillance  Monitoring of key health events through sentinel:  Sites  Events  Providers  Vectors/animals SENSOR Sentinel Event Notification System for Occupational Risks Lead Poisoning Michigan, 1990 NONE 1-25 26-100 100+ Confirmed Work-Related Asthma Patients By Industry Type: 1988-1998 Michigan 4% 6% Manufacturing: n=960 Construction: n=36 16% 3% 71% Services: n=215 Trade: N=47 Miscellaneous: N=76 Data Sources         Notifiable diseases Laboratory specimens Vital records Sentinel surveillance Registries Surveys Administrative data systems Other data sources Lung and Bronchus Cancer (Invasive) 70 SEER Incidence and U.S. Mortality United States, 1973-1994 60 Number/100,000 50 40 30 20 10 Incidence Mortality 0 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 Year Birth Defects Monitoring Programs    Vital records Hospital discharge summaries Hospital records (active abstraction) Prevalence of Anencephaly and Spina Bifida Metropolitan Atlanta Congenital Defects Program, 1968-2000 25 Rate per 10,000 20 Prenatally Diagnosed Cases Hospital-based. LB & SB Babies Before Fortification After Fortifcation 15 10 5 0 68 71 74 77 80 83 86 89 92 95 98 Year of Birth Data Sources         Notifiable diseases Laboratory specimens Vital records Sentinel surveillance Registries Surveys Administrative data systems Other data sources 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  Median Serum Folate, NHANES III and 1999, 50 Nonpregnant Women, 15-44 years 4.8 14.5 Post fortification Percentile 40 30 20 10 0 Prefortification 0 10 20 30 40 Serum Folate, ng/ml Cesarean Deliveries United States, 1970-1992 30 Percentage 25 20 15 10 5 0 Year Data Sources         Notifiable diseases Laboratory specimens Vital records Sentinel surveillance Registries Surveys Administrative data systems Other data sources Ectopic Pregnancies United States 1980-1996 100000 80000 Number of 60000 Ectopic Pregnancies in 40000 women 15-44 20000 0 Year Data Sources         Notifiable diseases Laboratory specimens Vital records Sentinel surveillance Registries Surveys Administrative data systems Other data sources Other Data Useful for Surveillance    Vaccine Adverse Event Reporting System CDC Drug Service Miscellaneous Information Loop of Public Health Surveillance Public Reports Health Care Providers Summaries, Interpretations, Recommendations Health Agencies Analysis