Surveillance involves the systematic collection, analysis, and use of health data for decision-making. It serves as an early warning system and monitors the impact of interventions. There are different types of surveillance including community-based, hospital-based, and active/passive surveillance. Community-based surveillance engages community members to detect and report health events. Hospital-based surveillance relies on regular reporting from hospitals. Active surveillance actively seeks out cases, while passive surveillance waits for cases to be reported. The appropriate surveillance method depends on the context and challenges.
1) The document discusses surveillance in public health and describes its key components and purposes. Surveillance involves the systematic collection, analysis, and interpretation of health data to provide information for action.
2) An effective surveillance system is simple, flexible, timely, and produces high-quality data. It addresses an important public health problem and accomplishes its objectives of understanding disease trends, detecting outbreaks, and evaluating control measures.
3) The document outlines how to establish a surveillance system, including selecting priority diseases, defining standard case definitions, and developing regular reporting and data dissemination processes. Both passive and active surveillance methods are described.
The document describes the steps taken to investigate an outbreak of jaundice in Rohtak, India. People first noticed an unusual occurrence of jaundice cases that had not been seen in over 10 years. A house-to-house survey confirmed it was an outbreak. Laboratory tests of water samples found one-third failed orthotolidine tests and 3 of 5 samples had unsafe coliform counts. Additional observations revealed poor sanitation practices in the community that could have contributed to the spread of the disease.
This document discusses hospital outbreak investigations. It defines endemic and epidemic infections in hospitals. Common source and propagated epidemics are described. Steps in investigating outbreaks in hospitals and communities are provided, including forming an investigation team, developing a case definition, conducting epidemiological and laboratory analyses. The goals of outbreak investigations are outlined. Methods for confirming and controlling outbreaks are discussed.
This document discusses disease surveillance and the concept of a public health ecosystem. It describes key aspects of public health including promoting healthy lifestyles, researching disease prevention, and controlling infectious diseases. Disease surveillance is highlighted as a core public health function. An ideal public health information ecosystem is proposed, with different components like surveillance, immunization, and environmental health. The document explores what disease surveillance entails and presents the idea of a disease surveillance ecosystem that brings together different stakeholders like epidemiologists, nurses, and laboratory staff. It addresses current gaps and ways to prioritize and fill them. Finally, it considers exercises around building an ideal disease surveillance team and responding to syndromic surveillance alerts.
The document discusses health planning, including defining health planning, its purpose, health needs and demands, objectives and goals. It explains the planning cycle of planning, implementation, and evaluation. Key aspects of planning covered include analyzing the health situation, establishing objectives and goals, assessing resources, prioritizing, formulating the plan, programming and implementation, and evaluation. Monitoring and different types of evaluation are also defined. The document concludes by discussing India's National Health Policy of 2002 and its goals.
The unusual occurrence in a community or region of disease, specific health related behaviour (eg. Smoking) or other health related events (eg. Traffic accidents) clearly in excess of “expected occurrence.
1) The document discusses surveillance in public health and describes its key components and purposes. Surveillance involves the systematic collection, analysis, and interpretation of health data to provide information for action.
2) An effective surveillance system is simple, flexible, timely, and produces high-quality data. It addresses an important public health problem and accomplishes its objectives of understanding disease trends, detecting outbreaks, and evaluating control measures.
3) The document outlines how to establish a surveillance system, including selecting priority diseases, defining standard case definitions, and developing regular reporting and data dissemination processes. Both passive and active surveillance methods are described.
The document describes the steps taken to investigate an outbreak of jaundice in Rohtak, India. People first noticed an unusual occurrence of jaundice cases that had not been seen in over 10 years. A house-to-house survey confirmed it was an outbreak. Laboratory tests of water samples found one-third failed orthotolidine tests and 3 of 5 samples had unsafe coliform counts. Additional observations revealed poor sanitation practices in the community that could have contributed to the spread of the disease.
This document discusses hospital outbreak investigations. It defines endemic and epidemic infections in hospitals. Common source and propagated epidemics are described. Steps in investigating outbreaks in hospitals and communities are provided, including forming an investigation team, developing a case definition, conducting epidemiological and laboratory analyses. The goals of outbreak investigations are outlined. Methods for confirming and controlling outbreaks are discussed.
This document discusses disease surveillance and the concept of a public health ecosystem. It describes key aspects of public health including promoting healthy lifestyles, researching disease prevention, and controlling infectious diseases. Disease surveillance is highlighted as a core public health function. An ideal public health information ecosystem is proposed, with different components like surveillance, immunization, and environmental health. The document explores what disease surveillance entails and presents the idea of a disease surveillance ecosystem that brings together different stakeholders like epidemiologists, nurses, and laboratory staff. It addresses current gaps and ways to prioritize and fill them. Finally, it considers exercises around building an ideal disease surveillance team and responding to syndromic surveillance alerts.
The document discusses health planning, including defining health planning, its purpose, health needs and demands, objectives and goals. It explains the planning cycle of planning, implementation, and evaluation. Key aspects of planning covered include analyzing the health situation, establishing objectives and goals, assessing resources, prioritizing, formulating the plan, programming and implementation, and evaluation. Monitoring and different types of evaluation are also defined. The document concludes by discussing India's National Health Policy of 2002 and its goals.
The unusual occurrence in a community or region of disease, specific health related behaviour (eg. Smoking) or other health related events (eg. Traffic accidents) clearly in excess of “expected occurrence.
Integrated Disease Surveillance Project (IDSP) was launched by Hon’ble Union Minister of Health & Family Welfare in November 2004 for a period upto March 2010. The project was restructured and extended up to March 2012. The project continues in the 12th Plan with domestic budget as Integrated Disease Surveillance Programme under NHM for all States with Budgetary allocation of 640 Cr.
A Central Surveillance Unit (CSU) at Delhi, State Surveillance Units (SSU) at all State/UT head quarters and District Surveillance Units (DSU) at all Districts in the country have been established.
Objectives:
To strengthen/maintain decentralized laboratory based IT enabled disease surveillance system for epidemic prone diseases to monitor disease trends and to detect and respond to outbreaks in early rising phase through trained Rapid Response Team (RRTs)
Programme Components:
Integration and decentralization of surveillance activities through establishment of surveillance units at Centre, State and District level.
Human Resource Development – Training of State Surveillance Officers, District Surveillance Officers, Rapid Response Team and other Medical and Paramedical staff on principles of disease surveillance.
Use of Information Communication Technology for collection, collation, compilation, analysis and dissemination of data.
Strengthening of public health laboratories.
This document provides an overview of basic measurements used in epidemiology. It discusses tools like proportion, rate, and ratio. It also covers various measures of mortality like crude death rate, specific death rate, and proportional mortality rate. Measures of morbidity like incidence and prevalence are explained. The relationship between incidence and prevalence is described. Standardization techniques are introduced to make rates comparable between populations.
This document discusses epidemiological methods for studying the distribution and determinants of health events and applying that knowledge to disease control. It defines descriptive epidemiology as the study of disease occurrence, distribution, and patterns in populations. Descriptive methods are observational and can be cross-sectional or longitudinal. Descriptive epidemiology provides insights into disease frequency, trends, and risk factors to inform public health planning and resource allocation.
This document discusses the concepts of association and causation in epidemiology. It defines key terms like correlation, relative risk, odds ratio, and attributable risk which are used to measure the strength of association between different factors. It also differentiates between association and causation, explaining that correlation does not necessarily imply causation. The document outlines different types of causal relationships like necessary and sufficient, necessary but not sufficient, and neither necessary nor sufficient. It also discusses approaches used to study disease etiology and evaluate evidence for a causal relationship.
Epidemiology is defined as the study of the distribution and determinants of health-related states or events in specified populations. It aims to describe disease distribution and size in human populations, identify causative factors, and provide data to plan, implement and evaluate health programs. Some key aspects of epidemiology include infectious disease epidemiology, cardiovascular epidemiology, cancer epidemiology, and environmental epidemiology. Epidemiology is used to search for disease causes, describe population health status, discover natural disease histories, and help control diseases.
This document discusses and compares monitoring and surveillance in veterinary epidemiology. It defines surveillance as a more intensive form of monitoring that involves the gathering, analysis, and dissemination of disease data to support control actions. The key differences provided are that surveillance requires professional analysis and judgment to make recommendations, has formulated standards, and can differentiate between acceptable and unacceptable changes in disease status. Various types of surveillance systems and their uses in disease control planning and evaluation are also outlined.
The document discusses the epidemiological triad of agent, host, and environment. It describes disease agents as substances or forces that can initiate or perpetuate disease. Agents can be biological like viruses, bacteria, protozoa, or fungus. They can also be physical, chemical, mechanical, or nutritional. The host refers to humans and factors like demographics, biology, socioeconomics, lifestyle, and environment that influence susceptibility. The environment encompasses physical, biological, and psychosocial external factors that interact with host and agent.
This document provides an overview of the basic steps involved in disease outbreak investigations. It describes 8 main steps: 1) verifying the diagnosis and confirming the outbreak, 2) defining cases and conducting case finding, 3) tabulating and orienting the data, 4) taking immediate control measures, 5) formulating and testing hypotheses, 6) planning and executing additional studies, 7) implementing and evaluating control measures, and 8) communicating findings. The goals of an outbreak investigation are to identify the source of illness and guide public health intervention.
Epidemiology is defined as the study of the distribution and determinants of health-related states in populations. It differs from clinical medicine in that it focuses on groups rather than individuals and uses quantitative tools to study communities. Epidemiology has many uses including healthcare management by making community diagnoses, understanding disease processes, guiding public health practice through disease investigation and surveillance, and informing clinical practice and research through evaluating treatments and assessing effectiveness of diagnostic procedures. Overall, epidemiology provides essential population-level insights that aid in healthcare planning, policy development, and clinical decision-making.
This document discusses behavioral change communication (BCC) and its role in public health programs. It defines BCC as a research-based, client-centered approach aimed at promoting behavior change through benefit-oriented and professionally developed services. BCC principles include community involvement, self-esteem promotion, and voluntary participation. The document outlines BCC's role in HIV/AIDS prevention by increasing knowledge, promoting attitude change, improving skills, and reducing stigma. It also discusses using BCC to achieve reproductive and child health goals by targeting influencers like mothers-in-law. Challenges to effective BCC include integrating it fully into programs and ensuring financial and training resources for sustainability.
The Presentation explains basic models of disease causation, to understand the etiology or causes of disease & altered production and helps to understand the applicability of causal criteria applied to epidemiological studies.
The STUDY of the DISTRIBUTION and DETERMINANTS of HEALTH-RELATED STATES in specified POPULATIONS, and the application of this study to CONTROL of health problems."
This document discusses various epidemiological terms used to measure disease frequency and distribution in a population. It defines rate, ratio, and proportion as different ways of comparing two quantities, with rate expressing the occurrence of an event over time, ratio comparing the relative sizes or values of two quantities without a time component, and proportion expressing one quantity as a percentage of the whole. It also defines various epidemiological measures including incidence, prevalence, attack rate, case fatality rate, and different types of mortality rates.
outbreak investigation - types of epidemics and investigating themTimiresh Das
This document discusses an upcoming presentation on outbreak investigation. It begins with definitions of key terms like epidemic, outbreak, endemic, and pandemic. It then discusses determinants of disease outbreaks and types of epidemics. The objectives, steps, and examples of outbreak investigation are provided. Various factors related to outbreaks like incubation period, quarantine, herd immunity, and triggers for surveillance are defined.
This document discusses disease screening and provides information on various aspects of screening programs and tests. It defines screening as actively searching for unrecognized disease in apparently healthy individuals using simple tests. The key points are:
- Screening is part of secondary prevention and aims to detect diseases early when they may be still curable. It involves testing populations, not individuals with symptoms.
- An ideal screening test is both highly sensitive and specific, but in practice these factors typically have an inverse relationship. Sensitivity and specificity can be adjusted by changing the test cutoff criteria.
- For a screening program to be effective, the disease must be an important health problem that can be detected early and treated effectively to improve outcomes. The screening test
Community diagnosis is vital in health planning, evaluation and needs assessment, several types of indicators are valid to be used for community diagnosis including Socio-economic, demographics, health system, and living arrangements.
The document discusses the epidemiological approach and methods. There are two basic approaches: asking questions and making comparisons. Asking questions involves identifying health problems, who is affected, when and where issues occur, contributing factors, and actions that can be taken. Comparisons can be made between populations, subgroups, and time periods. Epidemiological studies systematically collect and analyze health data to describe problems, identify associated factors, and form hypotheses. There are two main types of studies: observational studies that observe groups without intervention and experimental studies that introduce a treatment to evaluate effectiveness compared to standard care.
The document discusses primary health care (PHC). It defines health as a state of complete physical, mental and social well-being, not just the absence of disease. PHC is defined by the WHO as essential health care made universally accessible through community participation and affordable costs.
The key principles of PHC include addressing main health problems through promotion, prevention, treatment and rehabilitation. Its essential components are environmental sanitation, disease control, immunization, health education, maternal and child care, nutrition, medical care, and treatment of local diseases. PHC relies on health workers like nurses and community workers to form a team and respond to community needs.
This document provides an overview of the dynamics of disease transmission. It discusses the key elements involved, including:
1) The infectious agent - the pathogen that causes disease. It covers aspects like infectivity, pathogenicity, and virulence.
2) The source or reservoir - where the infectious agent lives and multiplies, such as humans, animals, or the environment. It can be the starting point for disease occurrence.
3) Modes of transmission - how the pathogen moves between the reservoir and a susceptible host. This includes direct contact, droplets, vectors, and indirect transmission through vehicles like food, water, fomites etc.
It describes other important epidemiological concepts like incubation period, generation
There are several types of surveillance systems that monitor different areas. Security surveillance systems monitor changes within an assigned field using tools like video recordings and data analysis to alert of unwanted events. Health surveillance systems like those used by the WHO and schools monitor disease trends and outbreaks by collecting data from various sources. Home security cameras and sensors are also a type of smaller-scale surveillance system that monitors personal property. Weather surveillance systems use instruments like satellites and sensors to collect weather data and develop forecasts as well as monitor changes in weather patterns.
This document discusses public health surveillance. It begins by defining surveillance and its main components, which include the ongoing collection and analysis of health data to facilitate disease prevention and control. The document then lists the main uses of surveillance data, such as estimating disease burden and evaluating programs. It describes three main sources of surveillance data: individuals, healthcare providers, and environmental conditions. The document outlines the five main steps of surveillance and discusses selecting health problems for surveillance based on factors like disease severity. It also describes different data collection methods, like notifications, surveys, and disease registries. In closing, it outlines the flow of surveillance information between data providers, analysts, and those responsible for public health response and decision-making.
Integrated Disease Surveillance Project (IDSP) was launched by Hon’ble Union Minister of Health & Family Welfare in November 2004 for a period upto March 2010. The project was restructured and extended up to March 2012. The project continues in the 12th Plan with domestic budget as Integrated Disease Surveillance Programme under NHM for all States with Budgetary allocation of 640 Cr.
A Central Surveillance Unit (CSU) at Delhi, State Surveillance Units (SSU) at all State/UT head quarters and District Surveillance Units (DSU) at all Districts in the country have been established.
Objectives:
To strengthen/maintain decentralized laboratory based IT enabled disease surveillance system for epidemic prone diseases to monitor disease trends and to detect and respond to outbreaks in early rising phase through trained Rapid Response Team (RRTs)
Programme Components:
Integration and decentralization of surveillance activities through establishment of surveillance units at Centre, State and District level.
Human Resource Development – Training of State Surveillance Officers, District Surveillance Officers, Rapid Response Team and other Medical and Paramedical staff on principles of disease surveillance.
Use of Information Communication Technology for collection, collation, compilation, analysis and dissemination of data.
Strengthening of public health laboratories.
This document provides an overview of basic measurements used in epidemiology. It discusses tools like proportion, rate, and ratio. It also covers various measures of mortality like crude death rate, specific death rate, and proportional mortality rate. Measures of morbidity like incidence and prevalence are explained. The relationship between incidence and prevalence is described. Standardization techniques are introduced to make rates comparable between populations.
This document discusses epidemiological methods for studying the distribution and determinants of health events and applying that knowledge to disease control. It defines descriptive epidemiology as the study of disease occurrence, distribution, and patterns in populations. Descriptive methods are observational and can be cross-sectional or longitudinal. Descriptive epidemiology provides insights into disease frequency, trends, and risk factors to inform public health planning and resource allocation.
This document discusses the concepts of association and causation in epidemiology. It defines key terms like correlation, relative risk, odds ratio, and attributable risk which are used to measure the strength of association between different factors. It also differentiates between association and causation, explaining that correlation does not necessarily imply causation. The document outlines different types of causal relationships like necessary and sufficient, necessary but not sufficient, and neither necessary nor sufficient. It also discusses approaches used to study disease etiology and evaluate evidence for a causal relationship.
Epidemiology is defined as the study of the distribution and determinants of health-related states or events in specified populations. It aims to describe disease distribution and size in human populations, identify causative factors, and provide data to plan, implement and evaluate health programs. Some key aspects of epidemiology include infectious disease epidemiology, cardiovascular epidemiology, cancer epidemiology, and environmental epidemiology. Epidemiology is used to search for disease causes, describe population health status, discover natural disease histories, and help control diseases.
This document discusses and compares monitoring and surveillance in veterinary epidemiology. It defines surveillance as a more intensive form of monitoring that involves the gathering, analysis, and dissemination of disease data to support control actions. The key differences provided are that surveillance requires professional analysis and judgment to make recommendations, has formulated standards, and can differentiate between acceptable and unacceptable changes in disease status. Various types of surveillance systems and their uses in disease control planning and evaluation are also outlined.
The document discusses the epidemiological triad of agent, host, and environment. It describes disease agents as substances or forces that can initiate or perpetuate disease. Agents can be biological like viruses, bacteria, protozoa, or fungus. They can also be physical, chemical, mechanical, or nutritional. The host refers to humans and factors like demographics, biology, socioeconomics, lifestyle, and environment that influence susceptibility. The environment encompasses physical, biological, and psychosocial external factors that interact with host and agent.
This document provides an overview of the basic steps involved in disease outbreak investigations. It describes 8 main steps: 1) verifying the diagnosis and confirming the outbreak, 2) defining cases and conducting case finding, 3) tabulating and orienting the data, 4) taking immediate control measures, 5) formulating and testing hypotheses, 6) planning and executing additional studies, 7) implementing and evaluating control measures, and 8) communicating findings. The goals of an outbreak investigation are to identify the source of illness and guide public health intervention.
Epidemiology is defined as the study of the distribution and determinants of health-related states in populations. It differs from clinical medicine in that it focuses on groups rather than individuals and uses quantitative tools to study communities. Epidemiology has many uses including healthcare management by making community diagnoses, understanding disease processes, guiding public health practice through disease investigation and surveillance, and informing clinical practice and research through evaluating treatments and assessing effectiveness of diagnostic procedures. Overall, epidemiology provides essential population-level insights that aid in healthcare planning, policy development, and clinical decision-making.
This document discusses behavioral change communication (BCC) and its role in public health programs. It defines BCC as a research-based, client-centered approach aimed at promoting behavior change through benefit-oriented and professionally developed services. BCC principles include community involvement, self-esteem promotion, and voluntary participation. The document outlines BCC's role in HIV/AIDS prevention by increasing knowledge, promoting attitude change, improving skills, and reducing stigma. It also discusses using BCC to achieve reproductive and child health goals by targeting influencers like mothers-in-law. Challenges to effective BCC include integrating it fully into programs and ensuring financial and training resources for sustainability.
The Presentation explains basic models of disease causation, to understand the etiology or causes of disease & altered production and helps to understand the applicability of causal criteria applied to epidemiological studies.
The STUDY of the DISTRIBUTION and DETERMINANTS of HEALTH-RELATED STATES in specified POPULATIONS, and the application of this study to CONTROL of health problems."
This document discusses various epidemiological terms used to measure disease frequency and distribution in a population. It defines rate, ratio, and proportion as different ways of comparing two quantities, with rate expressing the occurrence of an event over time, ratio comparing the relative sizes or values of two quantities without a time component, and proportion expressing one quantity as a percentage of the whole. It also defines various epidemiological measures including incidence, prevalence, attack rate, case fatality rate, and different types of mortality rates.
outbreak investigation - types of epidemics and investigating themTimiresh Das
This document discusses an upcoming presentation on outbreak investigation. It begins with definitions of key terms like epidemic, outbreak, endemic, and pandemic. It then discusses determinants of disease outbreaks and types of epidemics. The objectives, steps, and examples of outbreak investigation are provided. Various factors related to outbreaks like incubation period, quarantine, herd immunity, and triggers for surveillance are defined.
This document discusses disease screening and provides information on various aspects of screening programs and tests. It defines screening as actively searching for unrecognized disease in apparently healthy individuals using simple tests. The key points are:
- Screening is part of secondary prevention and aims to detect diseases early when they may be still curable. It involves testing populations, not individuals with symptoms.
- An ideal screening test is both highly sensitive and specific, but in practice these factors typically have an inverse relationship. Sensitivity and specificity can be adjusted by changing the test cutoff criteria.
- For a screening program to be effective, the disease must be an important health problem that can be detected early and treated effectively to improve outcomes. The screening test
Community diagnosis is vital in health planning, evaluation and needs assessment, several types of indicators are valid to be used for community diagnosis including Socio-economic, demographics, health system, and living arrangements.
The document discusses the epidemiological approach and methods. There are two basic approaches: asking questions and making comparisons. Asking questions involves identifying health problems, who is affected, when and where issues occur, contributing factors, and actions that can be taken. Comparisons can be made between populations, subgroups, and time periods. Epidemiological studies systematically collect and analyze health data to describe problems, identify associated factors, and form hypotheses. There are two main types of studies: observational studies that observe groups without intervention and experimental studies that introduce a treatment to evaluate effectiveness compared to standard care.
The document discusses primary health care (PHC). It defines health as a state of complete physical, mental and social well-being, not just the absence of disease. PHC is defined by the WHO as essential health care made universally accessible through community participation and affordable costs.
The key principles of PHC include addressing main health problems through promotion, prevention, treatment and rehabilitation. Its essential components are environmental sanitation, disease control, immunization, health education, maternal and child care, nutrition, medical care, and treatment of local diseases. PHC relies on health workers like nurses and community workers to form a team and respond to community needs.
This document provides an overview of the dynamics of disease transmission. It discusses the key elements involved, including:
1) The infectious agent - the pathogen that causes disease. It covers aspects like infectivity, pathogenicity, and virulence.
2) The source or reservoir - where the infectious agent lives and multiplies, such as humans, animals, or the environment. It can be the starting point for disease occurrence.
3) Modes of transmission - how the pathogen moves between the reservoir and a susceptible host. This includes direct contact, droplets, vectors, and indirect transmission through vehicles like food, water, fomites etc.
It describes other important epidemiological concepts like incubation period, generation
There are several types of surveillance systems that monitor different areas. Security surveillance systems monitor changes within an assigned field using tools like video recordings and data analysis to alert of unwanted events. Health surveillance systems like those used by the WHO and schools monitor disease trends and outbreaks by collecting data from various sources. Home security cameras and sensors are also a type of smaller-scale surveillance system that monitors personal property. Weather surveillance systems use instruments like satellites and sensors to collect weather data and develop forecasts as well as monitor changes in weather patterns.
This document discusses public health surveillance. It begins by defining surveillance and its main components, which include the ongoing collection and analysis of health data to facilitate disease prevention and control. The document then lists the main uses of surveillance data, such as estimating disease burden and evaluating programs. It describes three main sources of surveillance data: individuals, healthcare providers, and environmental conditions. The document outlines the five main steps of surveillance and discusses selecting health problems for surveillance based on factors like disease severity. It also describes different data collection methods, like notifications, surveys, and disease registries. In closing, it outlines the flow of surveillance information between data providers, analysts, and those responsible for public health response and decision-making.
The document summarizes a term paper on public health surveillance in Nepal. It discusses the objectives, methodology, findings and conclusions of the paper. The key points are: public health surveillance involves ongoing collection and analysis of health data to guide public health practice; Nepal has integrated disease surveillance within its health management information system; and the country was commended for its efficient AFP surveillance and polio eradication efforts while still needing to address potential wild poliovirus circulation.
This document discusses different types of surveillance including electronic, computer, audio, visual, and biometric surveillance. It provides examples of various surveillance methods such as electronic article surveillance, social network analysis, wiretapping, red light cameras, and gait analysis. The document also discusses debates around surveillance powers and technologies used by law enforcement.
This document discusses disease surveillance methods. It defines surveillance as the systematic collection and analysis of health data to guide disease control activities. Surveillance can be either passive, relying on routine reporting from healthcare providers, or active, involving direct identification of cases. Both methods have advantages and limitations. The document reviews reasons for conducting surveillance like detecting outbreaks and evaluating health programs. It also provides examples of how to analyze surveillance data by person, place, and time to identify trends and target public health efforts.
Surveillance for Public Health Issues in Specific Situation.pptxAtoillahIsvandiary
Public health surveillance is used to monitor population health status, measure needs for interventions, and assess effects of interventions. The document discusses different types of surveillance including active, passive, categorical, integrated, and syndromic surveillance. It also discusses using surveillance to monitor specific public health issues like environmental health, injuries, bioterrorism, disasters, refugees, and chronic diseases. The key is collecting, analyzing, and disseminating timely, useful data to inform public health decision-making.
Surveillance involves the ongoing collection and analysis of disease data to inform prevention and control measures. In Nepal, disease surveillance occurs through both routine monthly HMIS reporting from all health facilities, as well as sentinel surveillance through the Early Warning and Response System (EWARRS) which collects weekly data from selected sites. EWARRS focuses on priority diseases like polio, measles, neonatal tetanus, malaria, kala azar, and Japanese encephalitis to allow for early detection and response to outbreaks. The data collected through these surveillance systems are used for monitoring disease trends, outbreak detection, evaluating health services, and informing public health policies and programs.
Surveillance and Demographic Transition Theory-1.pptxMohammadYaseen97
Surveillance involves the ongoing systematic collection and analysis of health data that is essential for public health planning and evaluation. There are different types of surveillance including active, passive, and sentinel surveillance. Disease occurrence can be endemic, epidemic, or pandemic depending on the usual levels and trends in a population. The demographic transition theory describes the stages a population goes through as it shifts from high birth and death rates to low birth and death rates as a country develops economically. This includes an early expanding phase with decreasing death rates, a late expanding phase as birth rates start to decline, and eventually a low stationary stage with balanced low birth and death rates.
The document discusses public health surveillance, defining it as the ongoing systematic collection, analysis, and interpretation of health data that is disseminated to those responsible for prevention and control in order to take timely action. It describes the objectives, types (passive, active, sentinel), activities, attributes, and important diseases under surveillance in Ethiopia's Integrated Disease Surveillance and Response system. The goal of surveillance is to serve as an early warning system and guide public health practice.
The document discusses the basic principles of epidemiology in emergencies. It describes epidemiology as the study of disease distribution and causes. Descriptive epidemiology determines disease distribution, analytical epidemiology examines risk factors, and evaluation epidemiology assesses program effectiveness. Surveillance systems collect health data to monitor trends and detect outbreaks. Rapid needs assessments identify priority health issues to guide emergency response.
Surveillance involves the continuous monitoring of disease trends in a population to achieve several main objectives: (1) provide information on changing health status, (2) provide feedback to modify health policies and systems, and (3) provide timely warnings of public health issues. There are two main types of surveillance - active surveillance involves regular outreach to collect data, while passive surveillance uses data generated without contact by the monitoring agency, such as reports of certain diseases. Communicable disease surveillance monitors the frequency, distribution, and risk factors of infectious diseases that can spread between humans or from animals/environments to humans. The goals are to estimate disease burden, detect outbreaks, evaluate control programs, and facilitate planning.
This document discusses the importance of vaccine preventable disease (VPD) surveillance systems and provides details on setting up and monitoring different types of surveillance. It describes passive, sentinel, and active surveillance and compares their methods. Guidelines are provided for setting up each type of surveillance, including selecting reporting sites, collecting standardized case information, and monitoring the quality and timeliness of reporting. Methods for confirming vaccine preventable disease cases and preparing line lists and reports are also outlined.
The document provides an overview of the steps involved in investigating disease outbreaks. It describes 8 main steps: 1) verifying the diagnosis and confirming the outbreak; 2) defining cases and conducting case finding; 3) tabulating and orienting data by time, place and person; 4) taking immediate control measures; 5) formulating and testing hypotheses; 6) planning and executing additional studies; 7) implementing and evaluating control measures; and 8) communicating findings. The goals of an outbreak investigation are to identify the source of illness and guide public health intervention. Preparedness activities are also important for preventing and controlling future outbreaks.
IV Congresso Internacional CBA2017
Emerging Technologies and the Quality of Care
David W. Bates, MD, MSc, Chief, Division of General Internal Medicine, Brigham and Women’s Hospital, Past President, ISQua
Public health surveillance involves the continuous collection and analysis of health data to support public health practices. It can be used for immediate detection of epidemics or long-term monitoring of disease trends. Active surveillance employs staff to directly collect data while passive surveillance relies on voluntary reporting from healthcare providers. Syndromic surveillance monitors clinical symptoms before confirmation of diagnoses. Integrated disease surveillance at national and global levels aims to strengthen communicable disease monitoring through standardized guidelines and collaboration across networks.
surveillance.pptx. conceptual vice all aboutssuserf5da84
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The document discusses public health surveillance, providing definitions and outlining its goals, history, uses, types, attributes, and process. It describes key public health surveillance programs in India, including the Integrated Disease Surveillance Program (IDSP) and National Surveillance Programme for Communicable Diseases (NSPCD). The goal of public health surveillance is to provide information to guide public health policies and programs by ongoing collection and analysis of health data. Effective surveillance systems aim to detect health issues, monitor trends, and link data to appropriate public health actions and interventions.
This document discusses establishing surveillance programs in healthcare facilities to monitor infection risks. It recommends developing a written surveillance plan with clear goals and objectives. The plan should focus surveillance on high-risk patient groups, procedures, or pathogens. Data collection methods like active surveillance are most sensitive but also most resource-intensive. Targeted surveillance of specific infections or units allows resources to focus on the highest risks. Regular analysis and reporting of infection rates helps evaluate the surveillance program and direct prevention efforts.
INTRO HIV SURVEILLANCE PROF DR SANJEV DAVE.pptxSanjeevDavey1
The document provides an overview of HIV Sentinel Surveillance (HSS) and outlines the roles and responsibilities of personnel involved. It defines HSS as a system that monitors HIV prevalence among specified populations through consistent methodology at designated sites over time. The key objectives are to monitor trends, distribution, and spread of HIV prevalence to identify pockets of the epidemic and measure prevention progress. Personnel roles include implementing HSS according to guidelines, coordinating activities, conducting trainings, monitoring sites, and linking reactive participants to care. HSS is conducted among populations like antenatal clinic attendees, high-risk groups, and prisoners to estimate HIV burden and guide programming.
Coronary restenosis refers to the re-narrowing or reoccurrence of blockage in a coronary artery that has previously been treated with a procedure such as angioplasty and stent placement. Angioplasty is a procedure used to open narrowed or blocked arteries by inflating a balloon-like device to widen the artery, and a stent may be placed to help keep the artery open.
Restenosis can occur when the artery becomes narrowed again due to various factors, including the growth of scar tissue inside the artery, inflammation, or the formation of new plaque. Restenosis can lead to recurrent symptoms of chest pain (angina) or other complications.
To help prevent restenosis, doctors may recommend lifestyle changes such as quitting smoking, adopting a heart-healthy diet, exercising regularly, and taking medications to manage risk factors such as high cholesterol, high blood pressure, and diabetes. In some cases, additional treatments or procedures may be necessary to address restenosis, such as repeat angioplasty, stent placement, or bypass surgery. It's essential for individuals who have undergone coronary artery procedures to follow their healthcare provider's recommendations for monitoring and managing their heart health to reduce the risk of restenosis.
Arrhythmias are abnormal heart rhythms that can occur when the electrical impulses that coordinate the heartbeats are disrupted. There are different types of arrhythmias, including:
1. Atrial Fibrillation (AFib): This is the most common type of arrhythmia and occurs when the heart's upper chambers (atria) beat irregularly and out of sync with the lower chambers (ventricles).
2. Supraventricular Tachycardia (SVT): SVT is a fast heart rate originating above the ventricles, often in the atria.
3. Ventricular Tachycardia (VT): VT is a fast heart rate that starts in the heart's lower chambers (ventricles).
4. Ventricular Fibrillation (VFib): VFib is a life-threatening arrhythmia where the ventricles quiver instead of pumping blood effectively.
5. Bradycardia: This is a slow heart rate, usually below 60 beats per minute.
Arrhythmias can be caused by various factors, including heart disease, high blood pressure, diabetes, smoking, excessive alcohol consumption, stress, certain medications, and structural abnormalities in the heart. Some arrhythmias may not cause any symptoms, while others can lead to symptoms such as palpitations, dizziness, chest pain, shortness of breath, and fainting.
Treatment for arrhythmias depends on the type and severity of the condition. It may include lifestyle modifications, medications, medical procedures like cardioversion or ablation, or implantation of devices like pacemakers or implantable cardioverter-defibrillators (ICDs) to help regulate the heart's rhythm.
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2. Surveillance
"sur" means "from above" and "veiller" means
"to watch
Surveillance is a systematic process of
collection, transmission, analysis and feedback
of public health data for decision making.
3. • It serves as an early warning system for
impending public health emergencies.
• It document the impact of an intervention, or
track progress towards specified goals
• Monitor and clarify the epidemiology of health
problems, to allow priorities to be set and to
inform public health policy and strategies.
http://www.who.int/topics/public_health_surveillance/en
4. 4
A dynamic vision of surveillance
Collect and
transmit
data
Analyze
data
Feedback
information
Make
decisions
All levels use
information
to make
decisions
Collect and
transmit
data
Analyze
data
Feedback
information
Make
decisions
All levels use
information
to make
decisions
5. Steps in establishing and maintaining surveillance system
Establish Goals
Develop Case definitions
Select appropriate personnel
Acquire tools and clearances for
collection , analysis and dissemination
Implement surveillance system
Evaluate surveillance activities
6. Purpose of Surveillance
1. Establish the baseline of a health condition
2. Understand trends and pattern of disease
3. Detect outbreaks or emergence of new disease
4. Estimate the magnitude of health problem
5. Identify resources needed during and after public health
emergencies
6. Evaluate public health programs and control measures
7. Determine nature and history of disease
8. Monitor changes in infectious agents
9. Set research priorities
10. Stimulate research
11. Inform research plan and implementation
12. Support public health program planning
13. Monitor changes in public health practice
Source: Adopted from Thacker sb,Berkelman RI. Public health Surveillance1998
8. WHO’s standard protocol for Surveillance:
• Is the case definition clear? appropriate?
consistent throughout the surveillance system?
• Is the reporting mechanism clear? Efficient? of
appropriate reporting periodicity? available to
all relevant persons and institutions?
• Is the analysis of data appropriate? susceptible
to proper presentation? used for decision-
making?
• Do the personnel involved have a good
understanding of the value of the surveillance
system?
Source: WHO Recommended Surveillance Standards WHO/CDS/CSR/ISR/99.2
9. Analysis of Surveillance Data
A. Time
• Graph over time
B. Place
• Map
C. Person
• Breakdown by age, sex or personal characteristics,
vaccination status
11. Types of Surveillance:
(a) A focused location for surveillance (such as health
facility-based surveillance or community based
surveillance).
(b) A designated or representative health facility or
reporting site for early warning of epidemic or
pandemic events (sentinel surveillance).
(c) Surveillance conducted at laboratories for detecting
events or trends not necessarily evident at other sites.
(d) Disease-specific surveillance involving activities
aimed at targeted health data for a specific disease.
(Disease surveillance and notifiable disease reporting
system)
WHO integrated disease surveillance and response in the African region a guide for establishing community based surveillance
Population based
13. Community based surveillance:
• Community-based Surveillance (CBS) is an active
process of community participation in detecting,
reporting, responding to and monitoring health
events in the community.
• The main reporters are community members who
detect and report cases that might be otherwise
not be reported to health care facilities
• To do this , community awareness campaign is
essential to carry out like educating them about
the signs and symptom of disease.
14. • Low and middle income countries often uses
CBS to track diseases
• It is conducted by volunteers who receive
training on health conditions from health care
worker or health care facilities to detect and
report suspected cases to the facility
• The scope of CBS is limited to systematic on-
going collection of data on events and diseases
using simplified case definitions and forms and
reporting to health facilities
15. How to establish community based
surveillance in its catchment area?
(a) Mapping the catchment area and
determining the number of CBS focal points
needed.
(b) Identifying community representatives
willing to be CBS focal points and accepted
by the community to play such a role.
(c) Training the focal points regarding the use
of case definitions and actions, and timelines
for reporting intervals.
(d) Defines a mechanism for regular feedback
and support to the CBS.
16. CBS should be a routine function for:
(a) Pre-epidemic period (to provide early
warning or alerts)
(b) Period during epidemic (to actively detect
and respond to cases and deaths)
(c) Post-epidemic period (to monitor progress
with disease control activities)
Integrated disease surveillance and response in the african region ; A guide for establishing community based surveillance
17. Advantages:
• To facilitate easy and early reporting, to keep
vigilance at the community level
• To get the community involved so they
understand their health problems.
• To help people to be free from diseases
• To improve the health of the people
• Detecting individuals who do not seek medical
care
• Building health care network within
community
18. Disadvantages
• Sensitivity and specificity of case detection
• Positive predictive value of the trigger events
• Timeliness of reporting and
• Acceptability of the system, based on
interviews of key informants in a sample of
villages.
• All Health conditions are not suitable for CBS
For eg STDs because of their associated social
pressure and consequences
19. Hospital based surveillance
• The main reporter in this surveillance system is
physician or any proper system placed in hospital
for regularly reporting and capturing information.
• The hospital may assign any physician or proper
system to take responsibility for such reporting
• This type of surveillance requires an accurate
estimation of the demographic characteristics of
the population under surveillance
• The hospital administration should be fully
informed and understand the importance of
surveillance.
20. Selection of surveillance population and
participating hospitals
• It should be demographically and
geographically well defined, and data should
be available on e.g. age distribution and
numbers of births and deaths
• The numbers of children in specific age groups
• Surveillance is best initiated in a population
that has been stable and is expected to best
able during the period of surveillance.
21. • A population that uses a single hospital or a small
number of hospitals and has good access to it or
them would be ideal. A study is easiest to conduct
if a single large hospital serves the population and
if the services it provides are free.
• It is advisable to be aware of the sources of health
care in the population under surveillance and the
numbers of patients they care for.
• Actual size of a surveillance population that
would yield accurate estimates is difficult to
determine, given the paucity of data on
hospitalizations in developing countries and the
unknown sensitivity of each system in detecting
and testing cases of gastroenteritis.
22. Advantages:
• Hospitalizations are easy to detect and they
have good source of well structured data
• Hospitalizations represent a significant cost in
health resources.
• Hospitals are likely to have a laboratory
capability
23. Disadvantages:
• Health conditions of mild illness as individual
does not seek health care or require
hospitalizations
• Some conditions which are not tracked well in
hospitals. (eg MI lead hospitalization could give
false estimate of true incidence)
• Lack of Representativeness of Reported Cases
• Lack of Timeliness
• Inconsistency of Case Definitions
• To get the denominator i.e. population at risk for
calculating the incidence
24. The final design of surveillance ought to differ
based on the context and challenges existing
locally, therefore requiring customizable and
adaptable strategies to ensure the feasibility
of caring out surveillance.
26. Active Surveillance
• Active surveillance (“hot pursuit”)identifies cases
through screening of hospital admission records,
emergency department logs, medical wards, and
intensive care units and out-of-hospital facilities,
including nursing homes, radiology centers, and
physicians’ offices.
• Screening is the essential step in active
surveillance
• Appropriate screening terms and rigorous
standardized procedures are necessary to
minimize the number of missing cases.
Source: Comparison of Active and Passive surveillance for CerebrovascularThe Brain Attack Surveillance in Corpus Christi (BASIC) Project
27. • The system does not wait for:
Case-patients to come to health care
facilities
Health care facilities to report cases
• Health care workers actively reach out to
detect cases
• Surveillance comes in addition to routine
health care delivery.
• This method requires more resources than
passive surveillance, but is especially useful
when it is important to identify all cases
28. When to consider active surveillance?
Informed decision based on vaccine
characteristics, pre-licensure data, safety
profile of similar vaccine/s, safety signal, other
• IS and rotavirus vaccines
• Limited pre-registration data
• Variation in vaccine characteristics –annual
changes to seasonal influenza vaccine
• To address vaccine safety ‘concerns’ that may/have
damaged confidence
• Active surveillance will include cohort and clinical
trails.
29. Advantages
• Can be very sensitive
• Can collect more detailed information
• May be more representative.
Disadvantages
• High Cost
• Labor intensive
• Difficult to sustain over time.
30. Methodology:
• It was double blind placebo controlled ,
Randomized clinical trail to evaluate the efficacy
of three doses of Rotavac against severe
gastroenteritis which was conducted at three sites
(Delhi , Pune and Vellore) in India between 2010
& 2013
Subject recruitment and follow up:
Subjects enrolled 6-7 weeks of age
Active Surveillance for IS in a phase 3 efficacy
trail of a oral monovalent rotavirus vaccines in
India - Jacob John
31. •The phase 3 clinical trail enrolled 6799 children
across three sites ( Delhi -3799, Pune -1500,
Vellore- 1500)
Vaccine(Rotavac) Arm -4419
Placebo Arm-2191
32. • Randomized in 2:1 ratio to receive 3 doses of
vaccine or a placebo.
• The first 1/3rd of the participants enrolled in
the study at all three sites were followed for
their safety (staff doing daily contacts for 14
days as follow up for vaccine)
• 2/3rd included in the trail were followed
weekly until the age of two years of follow up.
• Caregivers were given mobile phones and
access to the study team whenever the child
suffered from the symptoms of acute
gastroenteritis.
33. Screening and management of suspected IS:
•Screening criteria for suspected IS were
identified and treated appropriately
•Each children with IS were identified and
examined by the study team and was taken for
pediatric consultation and hospitalization if
required
•All diagnosis was confirmed through
Ultrasound screening
34. Adjunction of Cases:
•Independent Case adjunction committee blinded
to the children allocation to different groups
reviewed all clinical reports and radiologic
evidence of IS cases and brightons criteria of IS
•This committee constitutes senior pediatric
surgeon , pediatric radiologist and pediatrician.
•Relative risk was calculated for 7 day ,14 day
and 60 day periods after any dose and 365 day
period after first dose.
36. Results:
The incidence rate of confirmed IS among
vaccine group was 94/100,000 child years (95%
CI ,41,185) and 71/100,000 child years years
(95% CI ,15,206) in Placebo group.
No temporal association with vaccination
(including 2 year of follow up, the
difference between the treatment arm was
not statistically significant
OR ratio calculated 1.34
37. Limitations:
• Due to usage of broad criteria for identifying
cases in active surveillance resulted in
screening of children with non specific illness
were also have undergone ultrasound
screening
• This surveillance has also diagnosed large of
transient cases .
38. Passive Surveillance
• Passive surveillance(or “cold pursuit” )ascertains
cases by searching hospital discharge diagnoses.
• Health care facilities or providers report cases as
they present in health care facilities
• No specific efforts are made to make sure all
cases are reported
• Surveillance is integrated to routine health care
delivery
• Cases are identified as per case definition
39. Strengths
• Large population cover
• Simple to operate/inexpensive
• Signal detection
• Hypothesis generation
• Triggers further investigation
• Cost
• Easier to design and carry out
• Useful for monitoring trends over time
40. Weaknesses
• Reporting biases –Under-reporting
• Stimulated reporting
• Inconsistent data quality/completeness
• Can’t determine AEFI incidence
• Not designed to assess causality
• Low sensitivity
• Amount of data available is limited
• May not be representative
41. Methodology: Retrospectively the medical
record of confirmed cases of IS in children under
age of five , treated during 2007-2012 at two
tertiary care hospitals(KMC and CSM Medical
university)
1. Study area and participating hospital: were
finalized for the surveillance site
Retrospective surveillance for IS in children
aged less than five years at two tertiary care
centers in India
- -J.V. Singh
42. 2. Case definition and data sources:
• Screening criteria to identify cases were
determined for five complete years .
• Inclusion criteria: Child<60 months of age with
confirmed diagnosis of IS, using the case
definition of Brighton collaboration
3. Data collection and analysis:
• The data was pooled and analyzed according to
age , sex, clinical signs, year and month of
hospitalization ,diagnostics and treatment
related characteristics
43. • The most common diagnostic methods used
were Ultrasonography and abdominal
radiography with most cases being treated
surgically (71%). The median length of
hospital stay was 8 days (range 1-40) and
mean was 10.2 days. Records of any fatality
due to intussusception were not found during
the review of the records.
44. Results:
• Over a five to six year observation period 187
confirmed cases of intussusception , were
identified , of which 75% were males. The
median age of intussusception was 8 months,
and most of the cases presented were below 12
months
• A possible trend in the distribution of cases
with the highest number of cases being
reported in the month of April and lowest in
the month of October.
45. Limitations
• Lack of complete data on immunization
• Inability to define the catchment area
• Tertiary care referral centers were selected ,so
might be most severe cases were covered.
46. Stimulated passive surveillance
• Health care facilities or providers report cases
as they present in health care facilities
• Special efforts made to maximize reporting
through reminders, visits
• Surveillance remains integrated to routine
health care delivery
47. Methodology:
•Surveillance of IS presenting in first year of life ,
within the period of 1st March 2008 & 31st March 2009
•BPSU was used in collaboration with BAPS
• Criteria for screening was established which
included:
Infants admitted with suspected or confirmed
cases of IS during the study period in NHS and
equivalent hospitals across UK and republic of
Ireland.
Prospective Surveillance study of the
management of IS in UK and Irish infants
- Lamiya Samad
48. Cases were classified according to
Brighton's collaboration criteria as Definite
(level1), Probable (level 2) or Possible (level
3).
• BPSU cards were sent to pediatric surgeons
and pediatricians to notify the cases of IS
meeting the case definition criteria
• Clinicians were then contacted with brief study
questionnaire on the epidemiology and clinical
features of IS
• Study response rate was calculated
• Duplication of cases identified
49. • Cases were then classified according to
internationally agreed and validated BCC
• Incidence rate was calculates using number of
definite cases as numerator and total number
of live birth ( from the office of national
health statistics by linking birth and death by
using NHS numbers in the cohort of babies
born in 2008 )
51. • The base line rate of incidence of
intussusception prior to the introduction of
rotavirus vaccine into UK vaccine schedule
was calculated.
• Baseline rates obtained for UK 24.8/100,000 &
Republic of Ireland 24.2/100,000
52. Limitations
• Only definite cases of intussusception was
included so may cause underreporting so there
may be underestimation of actual cases of IS
• It rely lot on clinical interest and involvement
so consistency and adherence to the study
protocol and validation is important
53. Active & Passive surveillance
(Integrated surveillance)
• A combination of active and passive systems using
a single infrastructure that gathers information
about multiple diseases or behaviors of interest to
several intervention programs.
• It require coordination and collaboration among
various programs, first line providers (veterinarians
or clinicians), epidemiologists, information system
specialists and laboratory personnel, design efforts
must consider each of these groups’ needs,
capabilities, limitations, logistical assets, budgetary
realities and legal requirements.
54. • In this study surveillance sites were identified
then retrospective view of all children was
taken. Hospital records of children 0-2 years of
age with intussusception treated between Jan
2010 to 31st Aug 2014 were undertaken at CMC
Vellore .This hospital caters to 1.9 million
outpatient and 120,000 inpatient annually
• 61 cases cases of intussusception in children
under two year were presented in hospital
Intussusception in southern India: Comparison of
retrospective analysis and retrospective surveillance
-Susan Jahangir
55. • Retrospective study
Cases were identified in two steps:
Ist step : Possible cases of IS were identified
through electronic search of the radiology
database and operation registers.
2nd step: the diagnosis of IS is then confirmed
by reviewing medical records , operation notes
and other investigations
• The study demonstrates IS identified through
active surveillance and those retrospective
surveillance differ in presentation , severity of
illness, need for intervention and outcome.
56. • Active surveillance in a vaccine trail was done
(N=1500) they were randomized in 2:1
• 16 cases of ultrasound diagnosed IS were identified
through active surveillance of cohort of 1500
children participating in rotavirus phase three trail.
• In active surveillance all participants were given
mobile phones and access to call centre around the
clock for the duration of follow up. Any child
having the history of symptoms of IS were
contacted to minimize the risk of developing IS .
• Suspected case was reviewed by pediatrician and
those having even transient IS were reviewed by
pediatric surgeon
57. Results IS presenting through routine care identified on
retrospective analysis (Passive surveillance)
• 61 cases were identified
• The median time of onset and arrival to hospital was 48h.
• The median age at presentation was 214 days with 52 events
occurring in first peak of life
IS identified through active surveillance and referral of a
vaccine trail cohort (Active surveillance)
• 16 cases of IS were diagnosed out of which 7 meet the
level 1 criteria
• 6 met the level 2 criteria
• 3 met the level 3 diagnostic criteria
• 8 cases of IS Occurred in first year of life
• 16/444 positive ultra sonograms
58. Limitations
• As the data collected were from referral hospitals:
So the cases covered were the most serious cases
and therefore generalizability issues exists.
• Inability to define the catchment area for IS: cases
or to have the birth cohort data for the catchment
population under study
• Lack of complete immunization data: It was
difficult to identify the exact number and type of
immunization administered prior to
hospitalization for IS
59. Sentinel Surveillance
Choose key “location” to monitor for condition
of interest. “Locations” might include
• Sites
• Events
• Providers
• Animals/Vectors
• Choose a “location” that is most susceptible to
change.
60. The following criteria should be considered in
selecting a sentinel health facility (usually a
general or infectious disease hospital) :
• It should be willing to participate.
• It serves a relatively large population that has
easy access to it.
• It has medical staff sufficiently specialized to
diagnose, treat and report cases of the disease
under surveillance.
• It has a high-quality diagnostic laboratory.
Source:http://www.who.int/immunization/monitoring_surveillance/burden/vpd/surveillance_type/sentin
el/en
61. • Sentinel surveillance system is used when high-
quality data are needed about a particular disease
that cannot be obtained through a passive system.
• Selected reporting units, with a high probability
of seeing cases of the disease in question, good
laboratory facilities and experienced well-
qualified staff, identify and notify on certain
diseases.
• Whereas most passive surveillance systems
receive data from as many health workers or
health facilities as possible, a sentinel system
deliberately involves only a limited network of
carefully selected reporting sites.
62. • For example, a network of large hospitals might be
used to collect high-quality data on various diseases
and their causative organisms, such as invasive
bacterial disease caused by Haemophilus influenzae
type b, meningococcus or pneumococcus
• The success of this approach lies in execution of a
system-wide design process that fosters
communication and collaboration amongst the
multiple stakeholders operating within a
surveillance system, two elements that are pivotal
for building effective and agile coordinated national
response to local and international public health
emergencies.
63. Disadvantage:
• If the site is not selected properly, data may
not be representative of general population ,
thereby proving inadequate estimates of
incidence and prevalence.
64. Incidence of intussusceptions in Singaporean children
aged less than 2 years: a hospital based prospective study
-Kong Boo Phua
• This was prospective, hospital-based, multi-centre
surveillance study was conducted in hospital
• All children aged < 2 years and admitted to the study
hospitals with a diagnosis of IS–categorized as definite
(ascertained by: radiograph, surgery or by post-mortem
examination), probable, possible or suspected cases
based on the criteria developed by the Brighton
Collaboration Working Group were enrolled.
• Data on IS were obtained from the daily admission
logs, computerized hospital admission records,
emergency department records, surgical records and
radiology logs etc
65. • All departments that were responsible for the
management of IS cases were advised to
contact the study personnel for each case of IS
to ensure that all cases were captured
• Annual Incidence of IS
= Number of new IS cases reported in a specific year*100,000
The total number of children living in Singapore during the specific year
66. Results:
• Of the 178 children assessed, 167 children with
definite IS cases were considered for final
analyses; 11 were excluded (six diagnosed as
probable IS and four diagnosed as suspected IS;
one child’s parents withdrew consent).
• The overall incidence of IS was 28.9 (95% CI:
23.0–34.8) and 26.1 (95% CI: 22.2–30.0) per
100,000 child-year in children < 1 year and <
2 years of age, respectively. The majority of IS
cases (20 [12.0%]) were reported in children aged
6 months.
68. Prospective Study - looks forward, looks to
the future, examines future events, follows a
condition, concern or disease into the future
Study begins here
Time
69. Retrospective Study - “to look back”, looks
back in time to study events that have already
occurred
Time
Study begins here
70. 1. Cohort Design:
• A cohort is any group of people who are linked
in some way and followed over time.
• This group is then compared to a similar group
that hasn't been exposed to the variable.
• Researchers observe what happens to one
group that's been exposed to a particular
variable — for example, Infants who were
vaccinated or non vaccinated whether they
develop the disease outcome.
71. • Follows two or more similar groups that differ
with respect to whether they received a
vaccine (the “exposure”) to determine
how/whether the vaccination affects rates of
one or more AEs (the “outcome”)
72. Source: centre for disease control; Vaccine for children program
Cohort Study Design
74. Strengths:
• Exposure status determined before disease
detection
• Subjects selected before disease detection
• Can study several outcomes for each exposure
Limitations:
• Expensive and time-consuming
• Inefficient for rare diseases or diseases with
long latency
• Loss to follow-up
75. 2. Self controlled case series design:
• Simple method that uses data on case patients
alone (i.e. without external Control group)
• To assess safety or risk exists in defined time
intervals after vaccinations.
• SCCS method compares the Relative incidence of
IS within the risk window of interest with the
incidence of risk outside the window of interest.
• Robust and cost efficient approach and can be
applied in resource poor settings or baseline
disease surveillance before vaccine introduction
76. The major features of SCCS are that
(1) it automatically controls for time-fixed
covariates that don’t vary within a person during
the study period, and
(2) only cases (individuals with at least one event)
need to be included in the analysis.
• It includes only individuals who experienced
the AE. Each individual serves as his or her own
control. The analysis inherently controls for
covariates that remain stable during the study
period—for example, race and sex.
• SCCSs compare outcome event rates both post
vaccination and prevaccination to calculate the
relative incidence of AEs
77. Self control case series study Design
2 3 4 5 6 7
8
Vaccination
“Risk”
Window
Period outside the risk window(“Control”)
78. • Potential time fixed confounders are of lesser
concern in contrast to traditional case control
method as only case data is being used.
• The self-controlled case series (SCCS) represents
one particular methodology that may be useful for
active surveillance of drug safety.
• SCCS has strengths and weaknesses.
Modifications of the basic model can address
some but not all of the weaknesses.
Further research is required to establish the
operating characteristics of SCCS-based
active surveillance.
79. Limitations:
• As SCCS estimates the exposure-outcome
association in cases, it ignores data on
individuals in the study population that did not
experience the outcome event.
• SCCS approach concern the underlying
independence assumptions, in particular, the
assumption that events are conditionally
independent, and the assumption that the
exposure distribution and the observation
period must be independent of event times.
80. Methodology:
• Self-controlled case series is used by extracting
intussusception cases in infants <12 month age from
hospital databases (2005-2012) and with vaccination
histories from a national immunization registry.
• Relative incidences were calculated by comparing
incidence during defined risk periods after vaccination
with times outside these periods.
Risk Period: 1-7 days and 8-21 days after vaccination
with day 0 being the day of vaccination.
Non-risk period : time period before vaccination and
>21 days after a dose of rotavirus vaccine, within the 1-
to 12-month age observation period.
Intussusception and monovalent rotavirus vaccination
in Singapore Self-Controlled Case Series and Risk-
Benefit Study
- Chee-Fu Yung
81. Results:
Effect of vaccination program at 20% or 90%
coverage , compared with no program on
hospitalization attributable to rotavirus vaccination
Attributable to rotavirus IS in Singapore children,5
years old
82. Intussusception risk after rotavirus
vaccination in U.S. Infants W. Katherine Yih
Methodology:
Study Population: Children of age 5-36.9 wks to cover
recommended vaccination ages (2, 4, 6 months) plus
follow-up time and they were member of mini sentinel
data partners, Aetna, Health core and Humana between
Jan 2004 and Sep 2011.
• Cohort and self controlled case series were adopted
• Two risk intervals were specified for Rota Teq and
Rotarix i.e. 1-7 days and 1-21 days
• Medical records were reviewed to validate the vaccine
exposures and type of rotavirus vaccination
83. Cohort Design:
•1-21 Days- Exposed person time after
rotavirus vaccination.
•5-36 wks of age from unvaccinated infants
and before and after 0-21 Days of
rotavirus vaccination.
•Data from the study population itself is
used for the age adjustment
84. Self Controlled case interval design:
Risk interval ( or Windows) : 1-7 and 1-21 Days
Control interval : 22-42 Days
Adjusted for age using the age-specific incidence
curve from Tate et al. and a randomization
method (As incidence rate of IS varies by week
of age)
89. Conclusion
• Evidence of association between IS and Rota Teq
was found which was highest in 3-7 days of first
dose.
• Evidence of association between IS and Rota rix
was also found which existed after second dose
• Relative Risk
Rota Teq -1.12( 95% CI :0.33-2.70) excess cases
per 100,000 (7 days after vaccination)
Rotarix- 1.54 (95% CI : 0.19-3.22) excess cases
per 100,000 (21 days after vaccination)
90. 3.Case Control study Design:
•Compares people who have a disease or
adverse event with people who do not
and compares exposure to vaccine in each
group to determine the relationship
between the vaccine and the
disease/event.
92. Strengths
• Less expensive and time consuming
• Efficient for studying rare diseases
Limitations
• Inappropriate when disease outcome for a
specific exposure is not known at start of study
• Exposure measurements taken after disease
occurrence
• Disease status can influence selection of
subjects
93. Methodology:
Population based Surveillance for IS (Dec
2000-Nov 2002)
Passive surveillance for hospitalized infants(
age< 1years) with IS was conducted in two
phases in south Delhi.
Age and sex specific estimates were used to
calculate the incidence of IS
Population-Based Incidence of Intussusception and a Case-
Control Study to Examine the Association of Intussusception
with Natural Rotavirus Infection among Indian Children
-Rajiv Bahl
94. The result obtained through passive
surveillance were linked with active hospital
based surveillance
Case control study of the association between
Rotavirus infection and Intussusception
Case selection: Infants irrespective of area
their area of residence were included for cases
(age 2-12 months ) who had a confirmed
diagnosis of IS by either Ultrasonography or
surgery
95. Control selection:
Infants (2-12 months of age) admitted to the
same hospital as the case patients but do not
have the IS
Assessment of case patients and control
subjects through questionaire
96. Active Surveillance:
•The community in south Delhi was selected of
population ~500,000
•Trained field worker conducted baseline house
to house survey to record the age and sex of
children ,5 years of age
•Total of 11,416 children were identified and
their age and sex specific estimates were used
as denominator for calculating the incidence of
IS
97. Results:
• Intussusception rates obtained ~ 18 cases per
100,000 infant years of follow up
• Patients with IS were assessed through
ultrasound reported that Rotavirus infection
was associated with increased distal wall
thickness and lymphadenopathy during illness
suggesting a plausible mechanism by which
rotavirus infection could cause IS
98. Limitations
• All patients in source population were not
covered because they either had died without
seeking medical care at hospital or have not
accessed it
• Less number of patients were included in the
study
99. Case cross over
• Study of “triggers” within an individual
• ”Case" and "control" component, but information
of both components will come from the same
individual
• ”Case component" = hazard period which is the
time period right before the disease or event onset
• ”Control component" = control period which is a
specified time interval other than the hazard
period
100. • This design was introduced to avoid control
selection bias.
• Case serves as it own control and it is similar
to retrospective cross over design except that
the investigator does not control when a
patient starts and stops being exposed to the
potential trigger.
102. • A case-crossover design was used. Cases of children
were the children admitted with a diagnosis of
intussusception hospitals in the city of Valencia, Spain,
from 2006 to 2009 (95 cases were selected< 2 years of
age)
• The association between the episode of intussusception
and the intake of prescription medication was assessed.
Case period :2, 7, and 15 days (before episode of IS)
Control period :for the same time window 1, 2, 3, and 4
months (prior to the episode of IS)
Association Between Medication and Intestinal
Intussusception in Children: A Case-Crossover Study
-Vega Garcia, Lourdes
103. Results:
• The association between the appearance of
intussusception in children and medication intake
in the immediately preceding period (2–15 days)
was assessed
• The association between intussusception and
prior drug use varied depending on the exposure
window:
15-day odds ratio (OR),1.45 (95% CI,0.86–2.43)
7-day OR, 1.46 (95% CI, 0.80–2.67)
2-day OR, 2.26 (95% CI, 1.10–4.64