Lessons for surveillance in the 21st century: A historical perspective from the past five millennia

This paper reviews some major epidemics in the past 5000 years in human history and derives 12 lessons in the context of epidemiologic surveillance. The corresponding 12 challenges proposed in this paper could be used to guide us in building a better and more comprehensive surveillance system in the 21^st century. This will be achieved by: continuing the evolvement and improvement of surveillance; maintaining on an ongoing basis; being systematic; being population-based; including risk and intervention indicators in the data base; more efficient data analysis; stimulating etiologic research; improving forecasting capability; linking to development of intervention; evaluating the intervention; better ways of information dissemination; and dissemination without prejudice.     

A method for evaluating systems of epidemiological surveillance

Epidemiological surveillance is the systematic collection, analysis and dissemination of health data for the planning, implementation and evaluation of public health programmes. Established surveillance systems should be regularly reviewed on the basis of explicit criteria of usefulness, cost and quality; systems should be modified as a result of such review. Attributes of quality include: (i) sensitivity, (ii) specificity, (iii) representativeness, (iv) timeliness, (v) simplicity, (vi) flexibility and (vii) acceptability. To date, evaluation of surveillance systems has been limited in scope and content. The evaluation method proposed in this article offers an organized approach to the evaluation of epidemiological surveillance systems. The usefulness of a surveillance system is measured by whether it leads to prevention or control or a better understanding of adverse health events. The measure can be qualitative, in terms of the subjective views of those using the system, or quantitative in terms of the impact of surveillance data on policies, interventions or the occurrence of a health event. The cost of a system includes indirect as well as direct costs, and should be measured in relation to the benefits obtained, such as reduction of medical-care expenses and of time lost from work. All elements of the system should be included in the cost: data collection, analysis and dissemination. The sensitivity of a surveillance system is its ability to detect health events (completeness of reporting). Its specificity is inversely proportional to the number of false positives it reports. Reports of a disease that do not meet the case definition are false positives, and may result in resources being wasted in investigating them.(ABSTRACT TRUNCATED AT 250 WORDS)     

Review of software for space-time disease surveillance

Disease surveillance makes use of information technology at almost every stage of the process, from data collection and collation, through to analysis and dissemination. Automated data collection systems enable near-real time analysis of incoming data. This context places a heavy burden on software used for space-time surveillance. In this paper, we review software programs capable of space-time disease surveillance analysis, and outline some of their salient features, shortcomings, and usability. Programs with space-time methods were selected for inclusion, limiting our review to ClusterSeer, SaTScan, GeoSurveillance and the Surveillance package for R. We structure the review around stages of analysis: preprocessing, analysis, technical issues, and output. Simulated data were used to review each of the software packages. SaTScan was found to be the best equipped package for use in an automated surveillance system. ClusterSeer is more suited to data exploration, and learning about the different methods of statistical surveillance.     

Public health surveillance: historical origins, methods and evaluation.

In the last three decades, disease surveillance has grown into a complete discipline, quite distinct from epidemiology. This expansion into a separate scientific area within public health has not been accompanied by parallel growth in the literature about its principles and methods. The development of the fundamental concepts of surveillance systems provides a basis on which to build a better understanding of the subject. In addition, the concepts have practical value as they can be used in designing new systems as well as understanding or evaluating currently operating systems. This article reviews the principles of surveillance, beginning with a historical survey of the roots and evolution of surveillance, and discusses the goals of public health surveillance. Methods for data collection, data analysis, interpretation, and dissemination are presented, together with proposed procedures for evaluating and improving a surveillance system. Finally, some points to be considered in establishing a new surveillance system are presented.     

A profile of the online dissemination of national influenza surveillance data

Background  

Influenza surveillance systems provide important and timely information to health service providers on trends in the circulation of influenza virus and other upper respiratory tract infections. Online dissemination of surveillance data is useful for risk communication to health care professionals, the media and the general public. We reviewed national influenza surveillance websites from around the world to describe the main features of surveillance data dissemination.     

Context enrichment of health risk surveillance data for use and application: conceptual considerations from an Australian perspective

Increasing the relevance of health surveillance data for use and application remains a critical issue among users and stakeholders. However methods for displaying and communicating health risk data could do more to enrich these data for use and application. There is too much focus on developers, users and stakeholders and not enough focus on pathway models of disease and health. A greater focus on pathway models would help detail a wider explanation of the health problems across sectors and encourage better acceptance of responsibility for their occurrence within other sectors. Contextual enrichment of health data would encourage a shared theory among these players that would permit greater use and application. Better use of data and its translation into information and increased policy traction are likely to be achieved through processes that effectively: (1) establish a shared theoretical base for risk behaviour surveillance; (2) deliver data about the health and developmental status of individuals living in contexts over time; (3) maintain a systems approach to monitoring and surveillance that builds capacity for development, ownership, access to and dissemination of the data outside of the health system and (4) achieve sustainable partnerships that produce more intersectoral engagement.     

Impediments to global surveillance of infectious diseases: consequences of open reporting in a global economy

Globalization has led to an increase in the spread of emerging and re-emerging infectious diseases. International efforts are being launched to control their dissemination through global surveillance, a major hindrance to which is the failure of some countries to report outbreaks. Current guidelines and regulations on emerging and re-emerging infectious diseases do not sufficiently take into account the fact that when developing countries report outbreaks they often derive few benefits and suffer disproportionately heavy social and economic consequences. In order to facilitate full participation in global surveillance by developing countries there should be: better and more affordable diagnostic capabilities to allow for timely and accurate information to be delivered in an open and transparent fashion; accurate, less sensationalist news reporting of outbreaks of diseases; adherence by countries to international regulations, including those of the World Trade Organization and the International Health Regulations; financial support for countries that are economically damaged by the diseases in question. The article presents two cases--plague in India and cholera in Peru--that illuminate some of the limitations of current practices. Recommendations are made on measures that could be taken by WHO and the world community to make global surveillance acceptable.     

Design and operation of state and local infectious disease surveillance systems.

Since 2001, increased attention has been focused on improving acute infectious disease surveillance systems. This article describes options for their design and operation. Systems designed primarily to detect individual cases of reportable diseases may differ from those designed to detect outbreaks or support design or evaluation of control programs. Timeliness, sensitivity, and predictive value of surveillance systems cannot all be maximized at the same time. Core activities of surveillance systems include collection, analysis, and dissemination of information about health events under surveillance. Doing these well requires attention to the mechanics of surveillance, such as making the health department accessible at all times to receive reports and provide consultation, and maintaining current directories of persons for dissemination of surveillance data, alerts, and recommendations. Rapid access to electronic representations of health events (eg, laboratory reports, patient records, or health care claims) provides great opportunities for more timely and complete surveillance. Some important information (eg, exposures, contacts) will still need to be collected directly from affected persons. One productive strategy is to collect core demographic and onset data on all cases and detailed clinical, exposure, and outcome data on a subset.     

A successful model of Road traffic injury surveillance in a developing country: Process and Lessons Learnt

ABSTRACT: BACKGROUND: Road Traffic Injuries (RTIs) are one of the leading causes of death and disability worldwide with 90% of global mortality concentrated in the low and middle income countries. RTI surveillance is recommended to define the burden, identify high risk groups, plan intervention and monitor their impact. Despite its stated importance in the literature, very few examples of sustained surveillance systems are reported from low income countries. This paper shares the experience of setting up an urban RTI surveillance program in the emergency departments of five major hospitals in Karachi, Pakistan. METHOD: We describe the process of establishing a surveillance system including assembling a multi-institution research group, developing a data collection methodology, carrying out data collection and analysis and dissemination of information to the relevant stakeholders. In the absence of a road safety agency, the surveillance system required developing individual partnerships with industry, police, city government, media and many other stakeholders. Impact of the surveillance is demonstrated by some initiatives in the local trauma system and improvements in road design to effect hazard reduction. CONCLUSION: We demonstrated that a functional RTI surveillance program can be established, and effectively managed in a developing country, despite lack of infrastructure and limitation of resources. Data utilization in the absence of well defined road safety infrastructure within the government is a challenge. More effective actions are hampered by the limited capacity in the transport and health sectors to do in-depth analysis through road safety audits and trauma registries.     

Exposure-related hypothermia mortality in the United States, 1970-79

This study describes exposure-related hypothermia deaths in the United States from 1970 to 1979. Mortality risk from hypothermia increases with age; at all ages, non-White men are at highest risk and White women at lowest risk. Counts of deaths from hypothermia based on information from death certificate data may be understated. Effective social intervention to prevent hypothermia mortality and morbidity requires better public health surveillance and intensive case-finding.