Causal Pathway of Disease or Disability n n
Causal Pathway of Disease or Disability n n n n Environment (pre-exposure) Hazard/agent Behavior/risk factor Exposure Pre-symptomatic phase Apparent disease Death
Selected Sources of Data n n n n Environmental monitoring systems Animals/vectors Individuals Laboratories Medical records Administrative records Police records Birth/death certificates
Data Sources and Methods for Surveillance n n n n Notifiable diseases Laboratory specimens Vital records Sentinel surveillance Registries Surveys Administrative data systems Other data sources
Data Sources/Methods n n n n Notifiable diseases Laboratory specimens Vital records Sentinel surveillance Registries Surveys Administrative data systems Other data sources
Current Status: National Notifiable Diseases Surveillance System (NNDSS) n n n CSTE/CDC collaboration List revised at annual CSTE meeting Voluntary reporting by states to CDC Reporting mandated at state level Reportable diseases vary by state
National Notifiable Disease Surveillance n n Reporting mandated by state law/regulation Health care providers, laboratories report to local HD (county) County HD submits reports to State Reports transmitted to CDC primarily through National Electronic Telecommunications System for Surveillance (NETSS)
50 United States 1973 -1998 45 Reported Cases per 100, 000 Population MUMPS 40 35 30 25 20 15 MUMPS — by year, United States, 1983– 1998 7 6 5 4 3 2 1 0 1983 10 1988 1993 1998 Year 5 0 1973 1978 1983 1988 Year 1993 1998
500 United States, 1963 -1998 Vaccine MEASLES — by year, United licensed States, 1983– 1998 450 30 400 Reported Cases (Thousands) MEASLES (Rubeola) 25 350 20 300 20 15 250 10 200 10 5 0 150 1983 1988 100 1993 1998 Year 50 0 1963 1968 1973 1978 1983 Year 1988 1993 1998
Passive vs. Active Surveillance n Passive - Provider-initiated Active - Health Department-initiated n
Data Sources n n n n Notifiable diseases Laboratory specimens Vital records Sentinel surveillance Registries Surveys Administrative data systems Other data sources
Salmonellosis Reported Cases per 100, 000 Population 30 (excluding Typhoid Fever) United States, 1967 -1997 Outbreak caused by contaminated pasteurized milk, IL 25 20 15 10 5 0 1967 1972 1977 1982 1987 1992 Year 1997
Salmonella—serotypes of isolates Reported isolates United States, 1973 -1998 Outbreak caused 30, 000 Enteritidis 27, 000 Typhimurium 24, 000 Other by contaminated pasteurized milk, IL Unknown 21, 000 18, 000 15, 000 12, 000 9, 00 0 6, 00 0 3, 00 0 0 1973 Typhimurium Enteritidis 1978 1983 Year 1988 1993 1998
Blood Lead Measurements 1975 -1981 18 110 Lead used in gasoline (thousan ds of tons) Predicted blood lead 100 16 Mean blood 14 lead levels g/dl 90 80 Gasoline lead 70 Observed blood lead 60 12 50 10 40 30 1975 1976 1977 Year 1978 1979 1980 8 1981
Data Sources n n n n Notifiable diseases Laboratory specimens Vital records Sentinel surveillance Registries Surveys Administrative data systems Other data sources
Use of NCHS Data Systems for Surveillance Vital Statistics u National Infant Mortality Surveillance (NIMS) u Linked: « birth records « death records
Data Sources n n n n Notifiable diseases Laboratory specimens Vital records Sentinel surveillance Registries Surveys Administrative data systems Other data sources
Sentinel Surveillance n Monitoring of key health events through sentinel: u Sites u Events u Providers u Vectors/animals
SENSOR Sentinel Event Notification System for Occupational Risks
Lead Poisoning Michigan, 1990 NONE 1 -25 26 -100 100+
Confirmed Work-Related Asthma Patients By Industry Type: 1988 -1998 Michigan 4% 6% Manufacturing: n=960 Construction: n=36 16% Services: n=215 3% 71% Trade: N=47 Miscellaneous: N=76
Data Sources n n n n Notifiable diseases Laboratory specimens Vital records Sentinel surveillance Registries Surveys Administrative data systems Other data sources
Lung and Bronchus Cancer (Invasive) United States, 1973 -1994 70 SEER Incidence and U. S. Mortality Number/100, 000 60 50 Incidence Mortality 40 30 20 10 0 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 Year
Birth Defects Monitoring Programs n n n Vital records Hospital discharge summaries Hospital records (active abstraction)
Prevalence of Anencephaly and Spina Bifida Metropolitan Atlanta Congenital Defects Program, 1968 -2000 Rate per 10, 000 25 Prenatally Diagnosed Cases Hospital-based. LB & SB Babies 20 Before Fortification 15 10 After Fortifcation 5 0 68 71 74 77 80 83 86 89 92 95 98 Year of Birth
Data Sources n n n n Notifiable diseases Laboratory specimens Vital records Sentinel surveillance Registries Surveys Administrative data systems Other data sources
Use of NCHS Data Systems for Surveillance n Population-based surveys National Health Interview Survey u National Health and Nutrition Examination Survey u n Provider-based surveys National Hospital Discharge Survey u National Ambulatory Medical Care Survey u
Median Serum Folate, NHANES III and 1999, Nonpregnant Women, 15 -44 years 4. 8 14. 5 Percentile 50 40 Post fortification 30 20 10 Prefortification 0 0 10 20 Serum Folate, ng/ml 30 40
Cesarean Deliveries United States, 1970 -1992 Percentage 30 25 20 15 10 5 92 19 90 19 88 19 86 84 19 Year 19 82 19 80 19 78 19 76 19 74 19 72 19 19 70 0
Data Sources n n n n Notifiable diseases Laboratory specimens Vital records Sentinel surveillance Registries Surveys Administrative data systems Other data sources
Ectopic Pregnancies United States 1980 -1996 100000 80000 Number of 60000 Ectopic Pregnancies in 40000 women 15 -44 20000 96 94 92 Year 90 88 86 84 82 80 0
Data Sources n n n n Notifiable diseases Laboratory specimens Vital records Sentinel surveillance Registries Surveys Administrative data systems Other data sources
Other Data Useful for Surveillance n n n Vaccine Adverse Event Reporting System CDC Drug Service Miscellaneous
Information Loop of Public Health Surveillance Public Reports Summaries, Interpretations, Recommendations Health Care Providers Health Agencies Analysis
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