Evaluation of epidemiologic surveillance practice in the public health service in Brazil]

The results of a process evaluation of the epidemiological surveillance activities in 948 health units, situated in 98 of the most populated cities of each State in the country are presented. The survey was conducted towards the end of 1985. The following aspects were analyzed: information system, data analysis, epidemiological investigation. Institutional insertion, vaccination activities, management aspects and capacitation of the health worker were considered as potential determinants of performance. Data were submitted to correspondence analysis and a process of ascendant hierarchical classification, using the statistical package "Systeme Portable Pour L' Analise de Données-SPAD". The performance pattern was not found to be homogeneous. Six different classes of epidemiological surveillance practice in the health units were observed. In 53.7% of the services visited, even the most elementary norms of activity were not complied with. The presence of vaccination activities in the health units was associated with better performance in epidemiological surveillance. The study points to the need to review the epidemiological surveillance model in use in Brazil. It is no longer acceptable to restrict the practice of epidemiology in health services to communicable diseases, now to manage programs and services without epidemiological information.     

Impfmeldepflicht in Sachsen-Anhalt

Vaccination registries are databases intended to assess and manage complete vaccination data of as many individuals as possible in a population under survey. The task of these registries is to identify low vaccination rates on the individual and population level, to enable systems of reminding individuals, to focus vaccination campaigns and to maximize overall vaccination coverage. Saxony-Anhalt is the only federal state of Germany to have a law that prescribes the reporting of vaccinations. Vaccinations of children up to the age of 7 are reported to the regional public health services. However, as the law provides no regulations as to how the data should be registered and processed, the development of a vaccination registry depends entirely on the initiative and cooperation of the ”players in vaccination”. The key players in vaccination in Saxony-Anhalt have recently created a Vaccination-Committee, which set out to develop the theoretical standards and a software prototype for the establishment of a computerized vaccination registry. Recent developments in the public health reporting system of Saxony-Anhalt (which strives to modernize its computerized assessment of child and adolescent health) are now opening the possibility to integrate the vaccination registry into the commercially available child health software.     

Epidemiological surveillance of occupational pathology: a program of the Piedmont region (PRiOR). The PRiOR Protection Group

A surveillance programme of exposures and health impairment from work (PRiOR) was developed in Piedmont Region during 1996-97, aiming to: (i) experiment and make available to the health and safety at work services methods and tools to detect currently under-reported cases of work related diseases (disease surveillance); (ii) and build up tools to predict exposure to occupational hazards (hazard surveillance). Within the framework of the disease surveillance system, an active search was carried out in hospital departments for sino-nasal cancer, pleuro-pericardial malignant mesotheliomas, bronchial asthma, and contact dermatitis (the last two diseases only when associated with hypersensitivity to agents possibly entailing occupational exposure). The programme tested and showed the feasibility of such a detection system on a regional basis; a pilot system was set up in order to collect the cases, assess them, and bring them to the attention of the health and safety at work services of the local health authorities. Case detection seems to have been rather complete, and time elapsed from first diagnosis has been kept to a minimum. The exposure histories of the collected cases show exposure patterns not only of historical, but also of current relevance. Evaluating the exposure status either by the occupational histories (neoplastic diseases) or by the hypersensitivity pattern and job title (allergic diseases), the proportion of occupationally exposed cases was remarkably high. At the end of the PRiOR programme, the active search procedures were considered to have yielded positive results. and are going to become a permanent surveillance system.     

湖北省2002年保持无脊髓灰质炎工作状况分析

目的 分析湖北省2002年保持无脊灰状态各项措施的实施状况。方法 根据全省各级报告的常规免疫／强化免疫报表、AFP病例个案表／随访表、主动监测表，国家／省脊灰实验室检验结果，使用EPIinfo软件进行统计分析。结果 湖北省2002年OPV免疫报告接种率均在95％以上，以省为单位AFP病例监测主要指标达到WHO的要求。结论 湖北省2002年保持无脊灰状态各项措施达到要求。建议进一步加强对免疫空白人群的监测和免疫。     

Überblick und Bewertung der verfügbaren Datenquellen zur Inzidenz impfpräventabler Krankheiten, zum Durchimpfungsgrad und zum Immunstatus in Deutschland

The surveillance of vaccine preventable diseases and vaccination coverage is necessary in order to deliver epidemiological data with respect to national vaccination recommendations and control targets. The data available on the incidence of vaccine preventable diseases, vaccination coverage, and immune status of the population are fragmentary and do not allow the epidemiological situation to be fully assessed. Although the majority of vaccine preventable diseases are under surveillance nationwide (by statutory reporting or sentinel surveillance), data are not available for some diseases. In addition, data on vaccination coverage are not collected centrally. Nationwide data on vaccination coverage are only available for children at school entry. Use of secondary data such as data from health insurance companies or associations of statutory health insurance physicians provides an opportunity to close gaps in knowledge and to improve the surveillance of vaccine preventable diseases.     

疫苗上市后安全性的准实时主动监测

疫苗上市后安全性监测是及时发现风险信号以确保疫苗安全的必要措施,包括被动监测与主动监测。其中,主动监测能够全面、持续的收集免疫接种后不良事件,及时发现并验证疫苗安全性信号,已经成为未来上市后安全性监测的主要发展趋势。随着信息时代的到来,主动监测可通过纵向链接多源电子医疗数据库开展分析,数据的快速传输与定期更新,使得接近...     

Safety of the yellow fever vaccine during the September 2001 mass vaccination campaign in Abidjan, Ivory Coast

In 2001, a vaccination campaign against yellow fever was carried out in Abidjan, Cote d'Ivoire. During the campaign and 4 weeks after an active surveillance system for adverse events following immunization (AEFI) was set up. More then 2.6 million doses were administered and 87 AEFI were notified. Eight suspected YF cases were reported after vaccination and considered as AEFI. However, none had IgM for YF and all recovered without sequels. This surveillance system provided reassuring data about the safety of the YF vaccine and proved that it is feasible to set up an active surveillance system during a mass campaign.     

上海市闵行区预防接种网上预约服务系统概述

上海市闵行区在以居民电子健康档案(Resident Health Records,EHR)为核心的预防接种信息化管理系统基础上,开发了防接种网上预约系统,并以网上预约系统为平台,形成了一套融预防接种记录查询、预防接种知情告知、疑似预防接种不良反应报告于一体的预防接种综合化服务管理模式,提高了预防接种服务水平及家长的满意度,也为推进社区基本医疗及其他公共卫生服务的网上预约积累了经验。     

2011年上海市静安区疑似预防接种后不良反应监测数据分析

[目的]分析2011年静安区疑似预防接种后不良反应（AdverseEventFollowingImmunization,AEFI）数据,为提高监测工作质量,维护预防接种安全性提供依据。[方法]在常规监测的基础上,2011年7～9月对5家预防接种门诊接种对象开展主动监测,记录AEFI发生时间、疫苗接种时间、疫苗种类、报告时间、临床表现等信息,并分析比较。[结果]2011年静安区报告AEFI共249例次,平均报告率为289．49次／10万剂次,以一般反应为主。主动监测报告率为910．84次／10万剂次,常规监测报告率为84．99次／10万剂次,主动监测报告率为常规监测报告率的10．7倍。常规监测与主动监测中,AEFI报告率较高的疫苗较近似,但并不完全一致。[结论]静安区常规AEFI监测有效开展,但监测敏感度和监测质量尚存在进一步提高的空间,影响监测敏感性和监测质量的因素尚有待于进一步探讨。     

围产保健与儿童保健监测的方法与应用

目的：研究最佳围产保健与儿童保健的监测方法与应用,为母婴与儿童提供及时,系统的保健服务。方法：新婚妇女在婚前检查时建立围产保健册、随后开始月经监测,确定早孕后,定期作产前复查等监测。直到产后42d为止;新生儿应在出生42d内建立儿童保健册,然后根据监测对象的年龄 常规体检的原则,完成相应年龄段的询问,体检、实验室检查与评价。监测全程均有质量控制措施,所有的监测结果均录入计算机。实现计算机化管理。结果：该监测系统已经在我国的32个县（市）中实施,覆盖地区的总人口超过2千万,从1993年至,围产保健监测系统已成地连续运转了8年,儿童保健监测系统已成功地连续运转了4年。结论：该围产保健与儿童保健监监适合我国,国情,运转顺利,对促进和提高当地的围产保健与儿童保健工作水平,提高我国人口素质将发挥重要作用。     

Exposure databases and exposure surveillance: promise and practice

Based on recent developments in occupational health and a review of industry practices, it is argued that integrated exposure database and surveillance systems hold considerable promise for improving workplace health and safety. A foundation from which to build practical and effective exposure surveillance systems is proposed based on the integration of recent developments in electronic exposure databases, the codification of exposure assessment practice, and the theory and practice of public health surveillance. The merging of parallel, but until now largely separate, efforts in these areas into exposure surveillance systems combines unique strengths from each subdiscipline. The promise of exposure database and surveillance systems, however, is yet to be realized. Exposure surveillance practices in general industry are reviewed based on the published literature as well as an Internet survey of three prominent industrial hygiene e-mail lists. Although the benefits of exposure surveillance are many, relatively few organizations use electronic exposure databases, and even fewer have active exposure surveillance systems. Implementation of exposure databases and surveillance systems can likely be improved by the development of systems that are more responsive to workplace or organizational-level needs. An overview of exposure database software packages provides guidance to readers considering the implementation of commercially available systems. Strategies for improving the implementation of exposure database and surveillance systems are outlined. A companion report in this issue on the development and pilot testing of a workplace-level exposure surveillance system concretely illustrates the application of the conceptual framework proposed.     

建立检验检疫系统免疫接种副反应监测系统的探讨

[目的]保证免疫接种实施的安全性。提高接种质量,减少免疫接种副反应事件的发生。[方法]分析建立免疫接种副反应监测系统的重要意义,介绍国外的现状,提出建立检验检疫系统免疫接种副反应监测系统的模式。[结果]世界卫生组织已于1968年建立了免疫接种副反应监测项目,全球已有60多个国家参加了该项目。我国检验检疫机构所属的各国际旅行卫生保健中心,每年要承担大量的免疫接种工作,发生免疫接种副反应的概率较高,因而,亟需建立免疫接种副反应监测系统。该系统应包括：数据库的建立；信息的收集、整理、发布；建立专家咨询委员会；建立回诊制度；施种人员的专业培训等。[结论]疫苗的安全性问题和免疫接种副反应问题,越来越受到关注,因此,建立检验检疫系统免疫接种副反应监测系统势在必行。     

Varicella surveillance in public elementary schools--Multnomah County, Oregon, 2002-2004

Varicella vaccination of school-aged children reduces the number of varicella cases and lost days of school. In 1996, the Advisory Committee on Immunization Practices (ACIP) recommended routine vaccination of all children aged 12-18 months, catch-up vaccination of all susceptible children before age 13 years, and vaccination of susceptible persons who have close contact with persons at high risk for serious complications and susceptible persons at high risk for exposure. In 1999, ACIP updated these recommendations to include vaccination requirements for child care and school entry. Since 2000, in accordance with ACIP recommendations, varicella vaccination requirements have been phased in for Oregon children who have not had varicella before starting out-of-home child care, kindergarten, or seventh grade; elementary school children will be fully covered by school year (SY) 2006-07. To monitor changes in varicella incidence, Oregon Health Services (OHS) and Multnomah Education Service District (MESD) started routine, individual, case-based varicella surveillance in Multnomah County public elementary schools (kindergarten through 5th grade) beginning SY 2002-03. This report describes the surveillance system, the incidence of varicella during SY 2002-03 and SY 2003-04, and the results of active surveillance for unidentified cases during SY 2002-03. The findings indicate that the number of varicella cases has decreased in Oregon and that establishing public elementary school-based varicella surveillance is feasible and useful.     

Safety of the yellow fever vaccine during the September 2001 mass vaccination campaign in Abidjan,Ivory Coast

In 2001, a vaccination campaign against yellow fever was carried out in Abidjan, Côte d’Ivoire. During the campaign and 4 weeks after an active surveillance system for adverse events following immunization (AEFI) was set up.More then 2.6 million doses were administered and 87 AEFI were notified. Eight suspected YF cases were reported after vaccination and considered as AEFI. However, none had IgM for YF and all recovered without sequels.This surveillance system provided reassuring data about the safety of the YF vaccine and proved that it is feasible to set up an active surveillance system during a mass campaign.     

Surveillance übertragbarer Krankheiten in der Perspektive des Infektionsschutzgesetzes

The Protection against infection Act creates a new legal basis to combat infectious diseases in Germany. A central topic is to reorganize surveillance of infectious diseases. The new mandatory reporting system defines three different individual case oriented reporting lines, two starting on the local public health level, one starting in laboratories dealing with diagnosis of certain agents. The selection of diseases resp. agents which will be covered by a certain reporting line was done by assessing the potential need for public health action if a case has been confirmed. Monitoring of coverage of vaccination especially in the target group “school beginners” is a further module of surveillance. The law explicitly places German surveillance activities in an European context. Key-elements of the reporting system (case definitions, minimal data set, included diseases/agents, documentation of measures) are prepared to deliver data which can be easily integrated in European surveillance activities. Nevertheless the legal framework of the system considers specific German conditions and technical objectives. In addition to the mandatory reporting system, sentinels will be implemented to complete epidemiological intelligence for action.     

Opportunity for healthy ageing: lessening the burden of adult pneumococcal disease in Central and Eastern Europe, and Israel

The population of the Region (Central Europe, Eastern Europe, and Israel) is ageing, necessitating preventative programmes to maintain a healthy and active lifestyle in older age groups. Invasive pneumococcal disease (including bacteremic pneumonia, bacteremia without a focus, and meningitis) has higher incidence, morbidity and mortality in older adults and is a substantial public health burden in the ageing population. Surveillance in the Region establishes a significant burden in older adults of invasive pneumococcal disease (IPD), which still appears to be under-estimated as compared with other countries, and this warrants an improvement in surveillance systems. The largest proportion of IPD in adults is bacteremic pneumonia. Community-acquired pneumonia (CAP), largely attributable to S. pneumoniae, can be bacteremic or non-bacteremic; the non-bacteremic forms of CAP also represent a significant burden in the Region. The burden of pneumococcal disease can be reduced with programmes of effective vaccination. Recommendations on pneumococcal vaccination in adults vary widely across the Region. The main barrier to implementation of vaccination programmes is low awareness among healthcare professionals on serious heatlh consequences of adult pneumococcal disease and of vaccination options. The Expert Panel calls on healthcare providers in the Region to improve pneumococcal surveillance, optimize and disseminate recommendations for adult vaccination, and support awareness and education programmes about adult pneumococcal disease.     

Smallpox vaccine adverse events among civilians--United States,January 24-February 18, 2003

During the civilian smallpox vaccination program, CDC and state health departments are conducting surveillance for vaccine-associated adverse events. In the first stage of the program, active surveillance is being conducted for potentially life-threatening, moderate-to-severe, and other serious adverse events and for vaccinia transmission to contacts of vaccinees (Table). Nonserious events are reported via passive surveillance and are expected to be underreported. This report summarizes smallpox vaccine adverse events reported among civilians vaccinated as of February 14, 2003, and received by CDC from the Vaccine Adverse Event Reporting System (VAERS) as of February 18.     

Smallpox vaccine adverse events among civilians--United States,February 18-24, 2003

During the civilian smallpox vaccination program, CDC and state health departments are conducting surveillance for vaccine-associated adverse events. In the first stage of the program, active surveillance is being conducted for potentially life-threatening, moderate-to-severe, and other serious adverse events and for vaccinia transmission to contacts of vaccinees (Table). Nonserious events are reported through passive surveillance and are expected to be underreported. This report summarizes smallpox vaccine adverse events reported among civilians vaccinated as of February 21, 2003, and received by CDC from the Vaccine Adverse Event Reporting System (VAERS) as of February 24.