DPR Korea

Training on Epidemiology and Use of Epidemiological

Software, DPR Korea, Nov 12 - Dec9, 2005
WHO/CSR
Principles of Disease
Surveillance

WHO/CSR
 Surveillance

Surveillance is the ongoing systematic

collection, collation, analysis and
interpretation of data; and the
dissemination of information to
those who need to know in order
that action may be taken

WHO/CSR
Rationale for Disease Surveillance

• The disease is of public health importance

• Caution!
– Is it worth the effort (money, human
resources)?
– Are relevant data easily available?
– Can action be taken?

WHO/CSR
 Objectives of surveillance
• Monitoring trends and estimate magnitude of health
problem
• Epidemic (outbreak) detection and prediction
• Monitor progress towards a control objective
• Monitor programme performance
• Estimate future disease impact
• Evaluating an intervention
• Understand characteristics of health events
• Distribution and spread
• Natural history
• Facilitate planning
WHO/CSR
Objective: To monitor the trend of laboratory confirmed
malaria and proportion due to P. falciparum

Cases of malaria in a region, 1992-1996

600

500
Others
400
Faciparum
300

200

100

0
1992 1993 1994 1995 1996
WHO/CSR
Objective: To detect outbreaks of dysentery by
monitoring number of blood diarrhoea cases

Cases of acute bloody diarrhoea in a rural district by month,

January 1994- April 1995
120
Cases
100

80

60

40

20

0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr
1994 1995
WHO/CSR
Objective: To monitor progress towards polio eradication
by monitoring the incidence of poliomyelitis
where wild poliovirus is isolated in children
under 14 years
Cases of poliomyelitis where wild poliovirus was isolated
in children in a rural district, 1980-1996
250
NID
Cases
200

150
NID

100

50

0
80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96
Objective: To monitor the ability of a TB programme to
ensure treatment completion and cure

Treatment completion and cure in TB cases, 1994-1997

1600
1400
1200
1000 Cases
800 Completion
600 Cure
400
200
0
1994 1995 1996 1997
WHO/CSR
Objective: To predict future trends of AIDS for health
service planning

Cases of AIDS in a city district, 1990-2004

700
600
500
400
300
200
100
0
90 91 92 93 94 95 96 97 98 99 00 01 02 03 04
 Steps in planning a
surveillance system
• Establish objectives
• Develop case definition
• Determine data source or data collection mechanism
• Develop data collection instrument
• Field-test methods
• Develop and test analytic mechanism
• Develop dissemination mechanism
• Assure use of analysis and interpretation
• Evaluation

WHO/CSR
 Case definition

• Clinical versus laboratory

• Level of case definition (suspected, probable,
confirmed)

• Example Influenza:
– Suspected: A person with sudden onset of fever
> 39C, respiratory symptoms, myalgias, headaches
– Probable: A suspected case , epidemiologically linked to
labortory-confirmed case
– Confirmed: A suspected case with virus isolation
or direct antigen detection

WHO/CSR
 Data source and data collection
mechanism
• Data source
– notifiable diseases
– vital statistics
– survey
– laboratory
– member of the public, media
– other information sources, e.g. sanitarian data,
metereological data, immunisation, nutrition

• Data collection
– passive vs active

WHO/CSR
 Dissemination mechanism

• Directly to all who need to know

• Press release to the public
• Reports, bulletins
• Others

WHO/CSR
 Assure use of analysis and
interpretation
• Control measures
– rapid response
– case management
– prevention programme (immunisation)
• Planning/ policy making
– epidemic preparedness
– policy modification
– prediction and future planning
• Feedback to the system

WHO/CSR
 Surveillance: Tasks
Detect
Peripheral level
Treat
Report

Analyse
Investigate
Intermediate level Report
Respond
Feedback
Analyse
Investigate
Central level Ministry Confirm
of Health Respond
Plan and Fund
Feedback

Analysis and feedback

Support
Regional/International level Policy and targets
WHO
Funding
 Surveillance: General Principle

Health Care System Public Health Authority

Reporting
Data Information

Analysis &
Evaluation Interpretation

Feedback
Action Decision

WHO/CSR
 Surveillance functions
Core function
• Reporting
• Detection
• Investigation & confirmation
• Analysis & interpretation
• Action / response

Support function
• Training
• Supervision
• Resources
• Standards / guidelines
WHO/CSR
Surveillance: Basic Ingredients

A good network of motivated people

Clear case definition and reporting mechanism

Efficient communication system

Basic but sound epidemiology

Laboratory support

Good feedback and rapid response

WHO/CSR
 Report

Lab. confirmation

Clinical case

Seek medical attention

Disease

Infected

Exposed
WHO/CSR
 What is the difference
between recording/reporting
and surveillance

WHO/CSR
Disease notification is not
the only method in
surveillance system!!!

WHO/CSR
Venice: L. Thaikruea
Venice: L. Thaikruea
Krop khun Krap