Overview of Public Health Surveillance

Denise Koo, MD, MPHEpidemiology Program Office

Centers for Disease Control and Prevention

Public Health Approach

Problem Response

Surveillance:What is the

problem?

Risk FactorIdentification:What is the

cause?

InterventionEvaluation:

Whatworks?

Implementation:How do you

do it?

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

ShigellosisUnited States, 1968-1998

00

55

1010

1515

YearYear

1968

1968

1973

1973

1978

1978

1983

1983

1988

1988

1993

1993

1998

1998

Rep

ort

ed

Cases p

er

100,0

00

Pop

ula

tion

Rep

ort

ed

Cases p

er

100,0

00

Pop

ula

tion

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

< 5.0< 5.0 5.0–9.95.0–9.910.0–19.910.0–19.9 >20.0>20.0

NA

NA

NA

NYCNYC

DCDC

PRPRVIVIGUAMGUAM

AM SAMOAAM SAMOA

CNMICNMI

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

TOXIC SHOCK SYNDROME (TSS)United States, 1983-1998

1983

1984

1985

1986

1987

1988 198

9

1990 199

1

1992 199

31994

19951996 199

71998

National Center for Infectious Diseases (NCID) data*

National Electronic Telecommunications System for Surveillance (NETSS) data

0

20

40

60

80

100

120

140

160

Year (Quarter)

Rep

ort

ed

Cases

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) United States, 1978-1998Outbreak

caused by potato salad, NM

Outbreak caused by potato salad, NM

Outbreak caused by sautéed onions, IL

Outbreak caused by sautéed onions, ILOutbreak caused by fermented fish/sea products, AK

Outbreak caused by fermented fish/sea products, AK

Outbreak caused bybaked potatoes, TXOutbreak caused bybaked potatoes, TX

Laboratory-confirmed cases*Laboratory-confirmed cases*NETSS dataNETSS data

00

1010

2020

3030

4040

5050

6060

7070

8080

9090

100100

110110

YearYear19781978 19831983 19881988 19931993 19981998

Rep

ort

ed

Cases

Rep

ort

ed

Cases

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

YearYear

Rep

ort

ed

Cases

(Th

ou

san

ds)

Rep

ort

ed

Cases

(Th

ou

san

ds)

Vaccine licensedVaccine licensed

00

5050

100

100

150

150

200

200

250

250

300

300

350350

400

400

450

450

500

500

1963

1963

1968

1968

1973

1973

1978

1978

1983

1983

1988

1988

1993

1993

1998

1998

MEASLES — by year, United States, 1983–1998MEASLES — by year, United States, 1983–1998

00

55

1010

1515

2020

2525

3030

YearYear

19831983 19881988 19931993 19981998Rep

ort

ed

Cases

(Th

ou

san

ds)

Rep

ort

ed

Cases

(Th

ou

san

ds)

MEASLES (Rubeola)United States, 1963-1998

20

10

Pertussis (Whooping Cough)United States, 1998

0

0

300

300

600

600

900

900

1,200

1,200

1,500

1,500

1,800

1,800

2,100

2,100

2,400

2,400

Age Group (Years)

Age Group (Years)

<1<1 1–41–4 5–95–9 10–1410–1415–1915–1920–2920–2930–3930–3940–4940–4950–5950–59>60>60

Rep

ort

ed

C

ases

Rep

ort

ed

C

ases

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)

YearYear

00

55

1010

1515

2020

2525

3030

3535

4040

4545

5050

5555

6060

19681968 19731973 19781978 19831983 19881988 19931993 19981998

Rep

ort

ed

Cases

Source: CDC. Summary of notifiable diseases. 1998.

Rate

/100,0

00 P

op

ula

tion

Year

Inactivated Vaccine

Oral Vaccine

0.001

0.01

0.11

10

1001000

19511956 19611966 1971197619811986 19911996

United States, 1968-1998

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

TetracyclineUnited States, 1988-1997

Source: Gonococcal

Isolate Surveillance

Project (GISP)

Percent

0

2

4

6

8

10

12

1988198919901991199219931994199519961997

PPNGTRNG

PPNG & TRNG

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

Foreign-born

Year

U.S.-born

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

0

4,000

8,000

12,000

16,000

20,000

Rep

ort

ed

C

ases

Tuberculosis United States, 1986-1998

(U.S.- and foreign-born persons)

Obesity

United States, 1987-1998

Not available

< 10 %

………….…….

10%-15%

>15%

Source: BRFSS 1998

Physical ActivityGeorgia 1998

Less than15,000$

15,000-24,999$

Responses

25,000-34,999$

35,000-49,999$

$50,000>

NOYES

PE

R C

EN

T