Infectious Disease Surveillance

Nkuchia M. M'ikanatha, Ruth Lynfield, Chris A. Van Beneden, Henriette de Valk, Nkuchia M. M'ikanatha, Ruth Lynfield, Chris A. Van Beneden, Henriette de Valk

• Publisher: Wiley-Blackwell
• Year: 2013
• ISBN:
  9781118543528
• Edition: 2
• Topic: Medicina
• Subtopic: Enfermedades infecciosas

This fully updated edition of Infectious Disease Surveillance is for frontline public health practitioners, epidemiologists, and clinical microbiologists who are engaged in communicable disease control.It is also a foundational text for trainees in public health, applied epidemiology, postgraduate medicine and nursing programs.

The second edition portrays both the conceptual framework and practical aspects of infectious disease surveillance. It is a comprehensive resource designed to improve the tracking of infectious diseases and to serve as a starting point in the development of new surveillance systems. Infectious Disease Surveillance includes over 45 chapters from over 100 contributors, and topics organized into six sections based on major themes.

Section One highlights the critical role surveillance plays in public health and it provides an overview of the current International Health Regulations (2005) in addition to successes and challenges in infectious disease eradication.

Section Two describes surveillance systems based on logical program areas such as foodborne illnesses, vector-borne diseases, sexually transmitted diseases, viral hepatitis healthcare and transplantation associated infections. Attention is devoted to programs for monitoring unexplained deaths, agents of bioterrorism, mass gatherings, and disease associated with international travel.

Sections Three and Four explore the uses of the Internet and wireless technologies to advance infectious disease surveillance in various settings with emphasis on best practices based on deployed systems. They also address molecular laboratory methods, and statistical and geospatial analysis, and evaluation of systems for early epidemic detection.

Sections Five and Six discuss legal and ethical considerations, communication strategies and applied epidemiology-training programs. The rest of the chapters offer public-private partnerships, as well lessons from the 2009-2010 H1N1 influenza pandemic and future directions for infectious disease surveillance.

SECTION TWO
Program Area Surveillance Systems

6
Active, population-based surveillance for infectious diseases

Chris A. Van Beneden¹, Melissa Arvay², Somsak Thamthitiwat³ & Ruth Lynfield⁴

¹Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
²Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
³International Emerging Infections Program, Thailand Ministry of Public Health–US CDC Collaboration, Nonthaburi, Thailand
⁴Minnesota Department of Health, St. Paul, MN, USA

Introduction

Active, population-based surveillance can be a powerful surveillance tool for monitoring infectious diseases and evaluating disease preventive strategies. As will be described in this chapter, an important strength of this intensive type of surveillance is its potential to provide comprehensive, accurate data on disease incidence that are generalizable to larger populations. We will illustrate the key components of active, population-based surveillance as it is implemented in two disparate settings—the Active Bacterial Core surveillance (ABCs) in the USA, a core component of the US Centers for Disease Control and Prevention’s (CDC) Emerging Infections Program (EIP) network, and the CDC’s analogous international program, the International Emerging Infections Program (IEIP), which is part of the larger Global Disease Detection initiative, a network of collaboration between Ministries of Health of 10 countries and the CDC. Both these programs seek to better understand the burden of emerging infectious diseases.

Emerging infections programs: an overview

In 1992, the Institute of Medicine issued the report Emerging Infections: Microbial Threats to Health in the United States [1]. This report defined emerging infections as “new, re-emerging, or drug-resistant infections whose incidence in humans has increased within the past two decades or whose incidence threatens to increase in the near future.” In late 1994, the CDC established the EIP, a collaboration among the CDC, state health departments, academic institutions and partners, including local health departments, public health and clinical laboratories, infection preventionists, healthcare providers, and other federal agencies. The objectives of the EIP are to assess the public health impact of emerging infections and to evaluate methods for their prevention and control.

Active Bacterial Core surveillance

ABCs is one of the core components of the US EIP [2]. FoodNet and FluSurv-NET, two other core EIP components, are described in Chapters 7, Part 1, and 12. Begun in 1995, ABCs now includes 10 geographically disparate surveillance areas in the USA: California (the three-county San Francisco Bay area), Colorado (five-county Denver area), New York (15-county Rochester and Albany areas), Tennessee (20-urban counties), and the entire states of Connecticut, Georgia, Maryland, Minnesota, New Mexico, and Oregon (Figure 6.1). In 2012 the population under surveillance was approximately 42 million persons, representing 13% of the US population (see http://www.cdc.gov/abcs). ABCs includes surveillance for six invasive bacterial diseases of public health importance: Streptococcus pneumoniae, groups A and B Streptococcus, Haemophilus influenzae, Neisseria meningitidis and meticillin-resistant Staphylococcus aureus.

Figure 6.1 Participating sites, Active Bacterial Core surveillance (ABCs), 2012.

ABCs measures the disease burden and documents the epidemiology of ABCs pathogens, tracks antimicrobial resistance, and contributes to development of vaccines and vaccine recommendations. ABCs also serves as a base from which applied epidemiologic research can be performed, including case–control studies to determine risk factors for disease, evaluation of a variety of strategies for prevention and control of disease, and measurement of the post-licensure vaccine impact on disease.

International Emerging Infections Program

As of 2012, 10 Global Disease Detection (GDD) regional centers had been established as binational or regional collaborations between host country Ministries of Health and the US Department of Health and Human Services/CDC. GDD is the CDC’s principal program for “developing and strengthening global capacity to rapidly detect, accurately identify, and promptly contain emerging infectious disease and bioterrorist threats that occur internationally” (http://www.cdc.gov/globalhealth/gdder/gdd/). Each GDD regional center consists of up to six capacity areas, and a core capacity area in each regional center is an IEIP. The first IEIP was developed in Thailand in late 2001 and built upon a collaboration between the Thailand Ministry of Public Health and the CDC that began in 1980 [3]. Active, population-based surveillance is a key component of the IEIPs. Population-based surveillance is currently ongoing in select areas within six countries: Bangladesh, Thailand, Kenya, China, Guatemala, and Egypt (Figure 6.2). Priorities for the population-based surveillance component of IEIP include diseases of both local and international importance, such as pneumonia, diarrhea, acute febrile illness, and meningoencephalitis, for which vaccines or other interventions may exist.

Figure 6.2 Location and inception dates for the International Emerging Infections Programs conducting population-based surveillance.

Definition and rationale for active, population-based surveillance

In general, passive surveillance is healthcare provider-initiated surveillance that relies on a healthcare provider or laboratory personnel to report an infectious disease to public health authorities. In contrast, active surveillance is initiated by a local, state, or national public health agency. In active surveillance public health personnel actively solicit reports of the disease of interest directly from a provider that has recognized a suspected or confirmed infection in a patient or from a laboratory that has identified the infectious agent. Population-based surveillance is surveillance conducted among an entire or a representative sample of a predefined population.

Active, population-based surveillance is often considered the “gold standard” of surveillance because it theoretically captures 100% of diagnosed cases in a well-defined population. The health data collected from active, population-based surveillance can be used to estimate the burden of disease (morbidity) and deaths (mortality) in both the population under surveillance and a larger geographic area with similar population characteristics and epidemiologic setting; to calculate age- and sex-specific disease incidence rates; to monitor disease trends over time; and to evaluate the impact of various public health interventions.

Methodology: setting up active, population-based surveillance

When setting up an active, population-based surveillance system, several factors need to be addressed proactively. These include the choice of the particular disease or pathogen to be monitored, communication with appropriate partners, methods for ensuring data quality, and the approach taken to analyze and disseminate data. In addition, the components that must be in place to ensure data reliability include a clear case definition, appropriate pairing of cases (numerator) and the population under surveillance (denominator), closely monitored collection and management of both epidemiologic and clinical data (in a...

Table of contents

• Cover
• Table of Contents
• Title
• Copyright
• Contributors
• Foreword to the Second Edition
• Foreword to the First Edition
• Preface to Second Edition
• Preface to First Edition
• Acknowledgments
• Weighing of the Heart
• SECTION ONE: Introduction to Infectious Disease Surveillance
• SECTION TWO: Program Area Surveillance Systems
• SECTION THREE: Internet- and Wireless-based Information Systems in Infectious Disease Surveillance
• SECTION FOUR: Molecular Methods, Data Analyses, and Evaluation of Surveillance Systems
• SECTION FIVE: Basic Considerations, Communications, and Training in Infectious Disease Surveillance
• SECTION SIX: Partnerships, Policy, and Preparedness
• Index
• End User License Agreement