Overview of Public Health Surveillance

Epidemiology Program Office

Centers for Disease Control and Prevention
 Public Implementation:
How do you
Health do it?

Approach Intervention
Evaluation:
What
works?
Risk Factor
Identification:
What is the
cause?
Surveillance:
What
is the
problem?
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
 Core Public Health Functions

• Assessment
• Policy development
• Assurance
 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
 SHIGELLOSIS
Reported cases per 100,000 population, by year,
United States, 1972-2002

Source: CDC. Summary of notifiable diseases. 2002.

 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
 HEPATITIS A
Reported cases per 100,000 population,
United States and U.S. territories, 2002

Source: CDC. Summary of notifiable diseases. 2002.

 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
Reported cases, by quarter,
United States, 1987-2002

Source: CDC. Summary of notifiable diseases. 2002.

 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
Reported cases, by year,
United States, 1982-2002

.
Data from the annual survey of State Epidemiologist and Directors of State Public Health Laboratories.
Source: CDC. Summary of notifiable diseases. 2002.
 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
 MEASLES
Reported cases, by year,
United States, 1967-2002

Source: CDC. Summary of notifiable diseases. 2002.

 PERTUSSIS
Reported cases*, by age group,
United States, 2002

*Of 9,771 cases, 25 were reported with unknown age.

Source: CDC. Summary of notifiable diseases. 2002.

 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, VACCINE ASSOCIATED
Reported cases by year,
United States, 1972-2002

Source: CDC. Summary of notifiable diseases. 2002.

 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
10 TRNG

PPNG & TRNG

8

6 Source: Gonococcal
Isolate Surveillance
Project (GISP)
4

0
1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 Year
Note: "PPNG" (penicillinase-producing ) and "TRNG" (tetracycline-resistant) N. gonorrhoeae refer to plasmid-mediated resistance to
penicillin and tetracycline, respectively.
 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
 TUBERCULOSIS
Reported cases among U.S.-born and foreign-born persons*,
by year, United States, 1990-2002

*In 2002, place of birth was unknown for 120 case-patients.

Source: CDC. Summary of notifiable diseases. 2002
 Obesity
United States, 1987-1998
 Physical Activity
Georgia 1998

Source: BRFSS 1998

 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 (Council of State and Territorial

Epidemiologists)/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, by year,
United States, 1977-2002

Source: CDC. Summary of notifiable diseases. 2002.

 MEASLES
Reported cases, by year,
United States, 1967-2002

Source: CDC. Summary of notifiable diseases. 2002.

 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
 SALMONELLOSIS
Reported cases per 100,000 population, by year,
United States, 1972-2002

Source: CDC. Summary of notifiable diseases. 2002.

 SALMONELLA
Reported isolates, by serotype and year,*
United States, 1976-2001

*Data from Public Health Laboratory Information System (PHLIS).

Source: CDC. Summary of notifiable diseases. 2001.
 Blood Lead Measurements 1975-1981
110 18
Predicted blood lead
100
Lead used
in 16
90 Mean
gasoline
blood
(thousands
lead
of tons) 80 Gasoline lead
14 levels
µ g/dl
70
Observed blood lead
12
60

50
10
40

30 8
1975 1976 1977 1978 1979 1980 1981
Year Source: Pirkle et al JAMA 272:284-91, 1994
 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
 Confirmed Work-Related Asthma Patients
By Industry Type: 1988-1998
Michigan

4%

6%

16%
Manufacturing: n=960
3% Construction: n=36
Services: n=215
71%
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)
United States, 1973-1994
SEER Incidence and U.S. Mortality
70

60

Incidence
50
Number/100,000

40 Mortality

30

20

10

0
73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94
Year
Source: Cancer Statistics Review, 1973-1994 Rate is age-adjusted to 1970 U.S. Population
 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
Prenatally Diagnosed Cases
Rate per 10,000

20 Hospital-based. LB & SB Babies

15 Before
Fortification After
Fortification
10

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
Physical Inactivity
United States, 1998
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,
Nonpregnant Women, 15-44 years
4.8 14.5
50

40
Post fortification
Percentile

30

20

10
Prefortification
0
0 10 20 30 40
Serum Folate, ng/ml
 Cesarean Deliveries
United States, 1970-1992
30

25
Percentage

20

15

10

Year Source: National Hospital Discharge Survey (NHDS)

 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
40000

20000
Pregnancies in
women 15-44 0

Year
Source: National Hospital Discharge Survey, NCHS, CDC
 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
Summaries,
Providers
Interpretations,
Recommendations
Health
Agencies

Analysis
 Overview of Public Health Surveillance

Epidemiology Program Office

Centers for Disease Control and Prevention