Importance of Data Management for Surveillance Meg Mc

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Importance of Data Management for Surveillance Meg Mc. Carron Epidemiologist Influenza Division, CDC

Importance of Data Management for Surveillance Meg Mc. Carron Epidemiologist Influenza Division, CDC

What is surveillance? • Main Entry: sur·veil·lance • Etymology: French, from surveiller to watch

What is surveillance? • Main Entry: sur·veil·lance • Etymology: French, from surveiller to watch over, from sur- + veiller to watch, from Old French veillier, from Latin vigilare, from vigil watchful • Date: 1802 : close watch kept over someone or something (as by a detective) • Although the word surveillance in French literally means "watching over”, the term is often used for all forms of observation or monitoring and not just visual observation.

Purpose of Public Health Surveillance • Assess public health status • Define public health

Purpose of Public Health Surveillance • Assess public health status • Define public health priorities • Evaluate programs • Trigger public health action

Rationale for surveillance The disease • • • Society Surveillance systems evolve Severity •

Rationale for surveillance The disease • • • Society Surveillance systems evolve Severity • Public and mass media interest Frequency in response to ever-changing • Will to prevent Communicability • Availability of data needs of society in general International obligations Costs and of the public health Preventability community in particular.

Surveillance ! n ”Surveillance is the ongoing process of io t c a systematic

Surveillance ! n ”Surveillance is the ongoing process of io t c a systematic collection, collation, analysis r o f and interpretation of data; AND the n it o a dissemination of information (to those who m r o need to know) in order that action may be f In taken”

What Does Strategic Information Mean? § Generating information and knowledge to influence policy making,

What Does Strategic Information Mean? § Generating information and knowledge to influence policy making, programmatic action and research • Which viruses are circulating, where, when, who is affected? • Contribute to vaccine selection • Determine intensity and impact of activity • Detect unusual events o Unusual viruses o Unusual syndromes o Unusually large/severe outbreaks § Understand the impact of influenza to guide policy and resource decisions nationally, regionally, globally

What do we mean by strategic information? Increasing emphasis on data use and utility

What do we mean by strategic information? Increasing emphasis on data use and utility ACTION! KNOWLEDGE Assessment Data demand generation DATA INFORMATION Analysis Understanding Application

Goals & Uses of Surveillance • Detect outbreaks or epidemics – Detect changes in

Goals & Uses of Surveillance • Detect outbreaks or epidemics – Detect changes in trends (in time, person and place) and health practices , portray natural history of diseases – Evaluate control measures, programs or investigations • Estimate magnitude of morbidity and mortality – Ensure equity in health care (mortality and morbidity) • Facilitate planning – Making projections, understanding burden of disease and justifying allocation and or redirection of resourcese – evaluate public policy • Stimulate epidemiologic research – Generate/ Test hypotheses (e. g. changes in health practice) – Identify risk factors (in-depth studies)

Uses of Public Health Surveillance • serves as an early warning system for impending

Uses of Public Health Surveillance • serves as an early warning system for impending public health emergencies; • documents the impact of an intervention, or track progress towards specified goals; and • monitors and clarifies the epidemiology of health problems, to allow priorities to be set and to inform public health policy and strategies.

What do we mean by strategic information? Increasing emphasis on data use and utility

What do we mean by strategic information? Increasing emphasis on data use and utility ACTION! KNOWLEDGE Assessment Data demand generation DATA INFORMATION Analysis Understanding Application

How Do We Accomplish Step One? Data Collection! MOH Provinc e District Is this

How Do We Accomplish Step One? Data Collection! MOH Provinc e District Is this Surveillance?

Quality Data = Quality Surveillance • Completeness • Timeliness of reporting • Usefulness of

Quality Data = Quality Surveillance • Completeness • Timeliness of reporting • Usefulness of the surveillance data and the surveillance system • Simplicity of the system • Acceptability of the system • Flexibility of the surveillance system • Sensitivity in surveillance • Specificity in surveillance • Positive predictive value • Representativeness of the surveillance system

Elements of a Surveillance System – N° of cases (Morbidity) ⇒ List of diseases,

Elements of a Surveillance System – N° of cases (Morbidity) ⇒ List of diseases, case definitions Numerator Denominator §–Context-specific N° of deaths (Mortality) §Limited number of diseases ⇒ Cause, reporting issues §Criteria §Prospective surveillance High morbidity (frequency) Population under surveillance structures High–Health mortality (severity) *k/time –Cemeteries, burial sites Epidemic potential (communicability, 1. Total population of country/town/… §Possible sources –Home visitors international obligations, preventability …) 2. Age and sex distribution Census, registration –Death registries § 3. Standardised case definition New arrivals/departures, births /deaths During emergencies : mapping, extrapolation Retrospective mortality survey (population movement) from vaccination survey, oral accounts Caution ! §underreporting Population movements / changes Census? feasibility – double counting §No Particular at risk (ex. orphans, need to be groups perfect single women)

Strategy: Active - Passive • Active – (Active search for cases in the community

Strategy: Active - Passive • Active – (Active search for cases in the community : active case finding) – Surveillance staff contact health facilities to obtain data • Passive – Health facilities send the information • Stimulated passive surveillance – Routine reporting through the normal channel following a special request / stimulus • Depending on the situation Þ Emergency Þ Epidemic or not Þ Available communication means Þ Available human resources

Strategy: Data flow Periphery Compiling weekly (Sat – Fri) Send on following Monday Intermediate

Strategy: Data flow Periphery Compiling weekly (Sat – Fri) Send on following Monday Intermediate level Compiling weekly Central level Compiling weekly reports Send on Tuesday Event Action Data Weekly report Data Monthly report Event Action Feedback Policy decisions

Types of data collection Collation Analysis Interpretation Communication Action • Data sources: – –

Types of data collection Collation Analysis Interpretation Communication Action • Data sources: – – – – Notifiable diseases list Laboratory specimens Vital records Sentinel surveillance Registries Surveys Administrative data systems Other data sources • Tools: – Forms – Data transfer

Summary • Data drives surveillance – Drives public health decisions – Drives public health

Summary • Data drives surveillance – Drives public health decisions – Drives public health actions – Drives vaccine strain selection, vaccine policy • Fundamental to a well functioning system is well planned & managed data