what are the 5 steps of surveillance?

New York: Oxford U Press, 2001:129. Good preparation in both categories is needed to facilitate a smooth field experience. The reasons for conducting active surveillance at this time are twofold. This aggregation of cases seems to be unusual, but frequently the public (and sometimes the health agency) does not know the denominator. Before leaving for a field investigation, consult laboratory staff to ensure that you take the proper laboratory material and know the proper collection, storage, and transportation techniques. In an outbreak of pneumococcal pneumonia in a nursing home in New Jersey, cases were more common in the north wing than in the south wing (Figure 6.6). This turned out to be the exact period during which a restaurant employee, diagnosed with hepatitis A in mid-October, would have been shedding virus while still working. Customer feedback is one of the best ways to build your restaurant's brand value. Emerg Infect Dis 2004;10:63742. Patients from the same physician practice or hospital who do not have the disease in question. MMWR 2003;52:5657. 1. All information these cookies collect is aggregated and therefore anonymous. Epidemiology in search of infectious diseases: methods in outbreak investigation. Only one case was identified in Sioux Falls, South Dakota, 60 miles away. As a field investigator, you must have the appropriate scientific knowledge, supplies, and equipment to carry out the investigation before departing for the field. What is the role of each? Using the epidemiologic data, the investigators were able to implicate the ultrasonic mist machine that sprayed the fruits and vegetables. In other words, by being familiar with the disease, you can, at the very least, round up the usual suspects.. Some simple and effective strategies protect portals of entry. Data collection tools. So they can make real-time traffic reports, helping . You may recall that the investigation of pneumonia among attendees of an American Legion conference in Philadelphia in 1976 that gave Legionnaires disease its name was not considered complete until a new organism was isolated in the laboratory some six months later.(48). Why do the people living in one particular area have the highest attack rate? Becker KM, Moe CL, Southwick KL, MacCormack JN. Thus you would look for exposures during the weeks of October 7 and 14, plus or minus a few days. You also need to know what supplies or equipment to bring to protect yourself. Consider again the gastroenteritis data in Table 6.8. A Detailed Intake Sheet Start by gathering as much information as you can from the client up front. Presented at 53rd Annual Epidemic Intelligence Service Conference, April 1923, 2004, Atlanta. 5 BIOSURVEILLANCE SYSTEMS The definitions of biosurveillance, disease surveillance, and public health surveillance all include the word systematic. For example, the outbreak of West Nile virus in Queens, New York, in 1999 was promptly investigated to determine the extent of the outbreak and risk factors for disease so appropriate control measures could be developed and implemented. Some clusters turn out to be true outbreaks with a common cause, some are sporadic and unrelated cases of the same disease, and others are unrelated cases of similar but unrelated diseases. Investigators enrolled 27 case-patients into a case-control study. Discovery and. Vaccinations promote development of specific antibodies that protect against infection. Conceptually, the next step after identifying and gathering basic information on the persons with the disease is to systematically describe some of the key characteristics of those persons. A spot map is a simple and useful technique for illustrating where cases live, work, or may have been exposed. We had two specialists from Africa. New Engl J Med 1992;326:11737. What does she do when she goes to Luverne? But there are steps you can take to protect yourself, like using a #VPN at all times. A case classified as probable usually has typical clinical features of the disease without laboratory confirmation. Whichever decision you make, you may be right or you may be wrong. J Infect Dis 1992;165: 7369. Public health surveillance is defined by the World Health Organization (WHO) as the continuous, systematic collection, analysis, and interpretation of health related data needed for the planning, implementation, and evaluation of public health practice. Nursing home staff did report that the 2 residents of the south wing who developed pneumonia did spend much of their time in the north wing. Statistical significance testing. For example, investigators of an outbreak of hepatitis B might characterize the cases by intravenous drug use and sexual contacts, two of the high risk exposures for that disease. Efforts to prevent fecal-oral transmission often focus on rearranging the environment to reduce the risk of contamination in the future and on changing behaviors, such as promoting hand washing. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. When an outbreak occurs, whether it is routine or unusual, consider what questions remain unanswered about that particular disease and what kind of study you might do in this setting to answer some of those questions. Arrange to bring a laptop computer, cell phone or phone card, camera, and other supplies. The clinical criteria should be based on simple and objective measures such as fever 40C (101F), three or more loose bowel movements per day, or myalgias (muscle pain) severe enough to limit the patients usual activities. For an environmental toxin or infectious agent that resides in soil, the soil may be decontaminated or covered to prevent escape of the agent. This is particularly true if the hypotheses were not well founded at the outset. Description: Name: Mason, M; Age: 40; Phone: 555-3756; Address: 34 Winifred Ave., Brookville, VA; County: Columbia; Sex: Female; Race: White; Disease: Lyme Disease; Date of Onset: 8/17/2006; Lab Confirmed? The health departments first responsibility is to protect the publics health, so if appropriate control measures are known and available, they should be initiated even before an epidemiologic investigation is launched. Centers for Disease Control and Prevention. Self study modules on Tuberculosis, Module 7: Confidentiality in Tuberculosis Control: Background. In 1989, a worldwide epidemic of a previously unrecognized syndrome occurred. In the outbreak setting, the investigators would need to specify time and place to complete the outbreak case definition. Cookies used to make website functionality more relevant to you. Method for calculating population attributable risk percent: ARP = Attack rate (risk) in total population, ARU = Attack rate (risk) in unexposed group. By dividing the number of cases by the size of the population, county-specific rates of ehrlichiosis can be calculated (Figure 6.9). A patient with a communicable disease such as tuberculosis, whether symptomatic or asymptomatic, may be treated with antibiotics both to clear the infection and to reduce the risk of transmission to others. Indeed, although implementing control and prevention measures is listed as Step 11 in the conceptual sequence, in practice control and prevention activities should be implemented as early as possible. You should also take care of personal matters before you leave, especially if the investigation is likely to be lengthy. Did this person ever go to Luverne? Single case of disease caused by an uncommon agent (e.g., glanders, smallpox, viral hemorrhagic fever, inhalational or cutaneous anthrax) without adequate epidemiologic explanation, Unusual, atypical, genetically engineered, or antiquated strain of an agent (or antibiotic-resistance pattern), Higher morbidity and mortality in association with a common disease or syndrome or failure of such patients to respond to usual therapy, Unusual disease presentation (e.g., inhalational anthrax or pneumonic plague), Disease with an unusual geographic or seasonal distribution (e.g., tularemia in a non-endemic area, influenza in the summer), Stable endemic disease with an unexplained increase in incidence (e.g., tularemia, plague), Atypical disease transmission through aerosols, food, or water, in a mode suggesting deliberate sabotage (i.e., no other physical explanation), No illness in persons who are not exposed to common ventilation systems (have separate closed ventilation systems) when illness is seen in persons in close proximity who have a common ventilation system, Several unusual or unexplained diseases coexisting in the same patient without any other explanation, Unusual illness that affects a large, disparate population (e.g., respiratory disease in a large population may suggest exposure to an inhalational pathogen or chemical agent), Illness that is unusual (or atypical) for a given population or age group (e.g., outbreak of measles-like rash in adults), Unusual pattern of death or illness among animals (which may be unexplained or attributed to an agent of bioterrorism) that precedes or accompanies illness or death in humans, Unusual pattern of death or illness among humans (which may be unexplained or attributed to an agent of bioterrorism) that precedes or accompanies illness or death in animals, Ill persons who seek treatment at about the same time (point source with compressed epidemic curve), Similar genetic type among agents isolated from temporally or spatially distinct sources, Simultaneous clusters of similar illness in noncontiguous areas, domestic or foreign, Large number of cases of unexplained diseases or deaths. The incubation period for hepatitis A ranges from 15 to 50 days (roughly 2 to 7 weeks), with an average incubation period of 2830 days (roughly one month). Eosinophilia-myalgia syndrome New Mexico. Surveillance and Integrity Review Section (SIRS) PCA Provider Agency Training Author: Minnesota Department of Human Services Subject: Surveillance and Integrity Review Section (SIRS) PCA Provider Agency Training Keywords: Surveillance and Integrity Review Section (SIRS) PCA Provider Agency Training Created Date: 1/12/2023 7:55:00 AM The need for communicating with the public health and clinical community has long been acknowledged, but the need for communicating quickly and effectively with elected officials and the public became obvious during the epidemics of West Nile Virus encephalitis, SARS, and anthrax. Whatever the criteria, they must be applied consistently to all persons under investigation. In some challenging investigations that yielded few clues, investigators have convened a meeting of several case-patients to search for common exposures. Introduction to Public Health Surveillance VOLUME 5, ISSUE 5 The stakeout is on-going. Attack rate (risk)in exposed groupAttack rate (risk)in unexposed group. Communitywide outbreak of Legionnaires disease associated with a grocery store mist machine. Visit my father and buy the locally produced ground beef that he sells in his store. This process, in which the outbreak is characterized by time, place, and person, is called descriptive epidemiology. It is often used if an outbreak has begun or is suspected to keep close track of the number of cases. A retrospective cohort study is the study of choice for an outbreak in a small, well-defined population, such as an outbreak of gastroenteritis among wedding guests for which a complete list of guests is available. A case definition is a standard set of criteria for deciding whether an individual should be classified as having the health condition of interest. Emerg Infect Dis 2004;10:140511. Description: Name; Rollins, W; Age: 45; Phone: 555-4771; Address: 127 Midland St.; Portland, VA; County: Columbia; Sex: Male; Race: White; Disease: Lyme Disease; Date of Onset: Mid May 2006; Lab Confirmed? Mahoney FJ, Hoge CW, Farley TA, Barbaree JM, Breiman RF, Benson RF, McFarland LM. The STEPS instrument is comprised of three different levels or "steps" of risk factor assessment: Step 1 (questionnaire), Step 2 (physical measures) and Step 3 (biochemical measures). Legionnaires disease: description of an epidemic of pneumonia. 5. Communitywide outbreak of Legionnaires disease associated with a grocery store mist machine. In a point-source epidemic of a known disease with a known incubation period, the epidemic curve can be used to identify a likely period of exposure. The 5 Whys and/or 8 Disciplines of Problem-Solving (8D) approaches are good root-cause analysis techniques that can help them work together on crafting a good problem statement, identifying the root cause/s, and brainstorming on appropriate solutions to address non-conformance. If you only had data through Week 35, that is, through point A, you might conclude that the outbreak is still on the upswing, with more cases to come. This communication usually takes two forms: Epi-X is the CDCs Web-based communications solution for public health professionals. Video surveillance Firms are allowed to engage in video surveillance in common areas, but not private spaces such as bathrooms or locker rooms. : Yes; Hospital Alerted: Yes; Lab Results: WB IgM+; Comments: Erythema migrans; fatigue, sweats, chills; Physician Reporting: Dr. New Engl J Med 1982;306:124953. Figure 6.9 Rates of Human Granulocytic Ehrlichiosis by County Wisconsin, May 1996December 1998. The illness was given the name eosinophilia-myalgia syndrome. Anthrax outbreak averted: public health response to a contaminated envelope on Capital HillWashington, DC, 2001. Active surveillance requires substantially more time and resources and is therefore less commonly used in emergencies. Objectives As an example, consider again the outbreak of Legionnaires disease that occurred in Louisiana described at the end of Step 6. An intermittent common-source epidemic (in which exposure to the causative agent is sporadic over time) usually produces an irregularly jagged epidemic curve reflecting the intermittence and duration of exposure and the number of persons exposed. Scan the column of attack rates among those who ate the specified items and consider the three criteria listed on the previous page. By asking about drug use in a second case-control study, the investigators implicated marijuana as the likely vehicle. The shape of the epidemic curve may provide clues about the pattern of spread in the population, e.g., point versus intermittent source versus propagated. Generalized myalgia at some point during the illness severe enough to affect the patients ability to pursue usual daily activities; No infection or neoplasm that could account for #1 or #2. 4. For example, acquired immunodeficiency syndrome (AIDS) and severe acute respiratory syndrome (SARS) both began with relatively specific case definitions. NY, New York; FL, Florida; NJ, New Jersey; PA, Pennsylvania; VA, Virginia; DC, District of Columbia; MD, Maryland; CT, Connecticut; F, female; M, male; W, white; B, black; A, Asian; W,H, white with Hispanic ethnicity; NY, New York; NBC, National Broadcasting Company; AMI, American Media Inc.; USPS, United States Postal Service; CBS, Columbia Broadcasting System; PCR, polymerase chain reaction; IHC, immunohistochemical staining; + positive; IgG, immunoglobulin G. Case status and anthrax presentation are described in the anthrax surveillance case definition in the Methods section. The Drug Development Process. Many clients simply want to give you the subjects name, age and address and leave it at that. N Engl J Med 1987;316:9938. Section 1: Introduction Section 2: Purpose and Characteristics of Public Health Surveillance Section 3: Identifying Health Problems for Surveillance Section 4: Identifying or Collecting Data for Surveillance Section 5: Analyzing and Interpreting Data Section 6: Disseminating Data and Interpretations Section 7: Evaluating and Improving Surveillance A narrow confidence interval indicates that the risk ratio is fairly precise. A p-value this small indicates that the null hypothesis is highly improbable, and the investigators rejected the null hypothesis. For smaller studies, a test called the Fisher Exact Test may be more appropriate. Interpreting an epidemic curve. Do they know anyone else with the disease? The following two-by-two table shows the data for beef and gastroenteritis. Many epidemiologists use the terms outbreak and epidemic interchangeably, but the public is more likely to think that epidemic implies a crisis situation. What vehicles are commonly implicated? Nash D, Mostashari F, Fine A, Miller J, OLeary D, Murray K, et al. Stay informed about our latest work in Privacy and Surveillance First name Last name Email ZIP code Snow; Phone: 555-1200; Date of Report: 11/24/06. Do they have anything in common with others who have the disease? In that situation, it may be useful to draw several epidemic curves with different units on the x-axis to find one that best portrays the data. It permits the investigator to distinguish epidemic from endemic disease. It is an axiom of field epidemiology that if you cannot generate good hypotheses (for example, by talking to some case-patients or local staff and examining the descriptive epidemiology and outliers), then proceeding to analytic epidemiology, such as a case-control study, is likely to be a waste of time. The answer is public health surveillance. Description: Name: Houston, M; Age: 56; Phone: 555-4897; Address: 4890 Pleasant St., Arlington, VA; County: Columbia; Sex: Female; Race: White; Disease: Lyme Disease; Date of Onset: 8/2/2006; Lab Confirmed? The risk ratio is calculated as the ratio of the attack rates or risks, i.e., 65.4% divided by 11.4%, which equals 5.7. Classifications such as confirmed-probable-possible are helpful because they provide flexibility to the investigators. The first method is likely to be used when the clinical, laboratory, environmental, and/or epidemiologic evidence so obviously supports the hypotheses that formal hypothesis testing is unnecessary. Description: Name: Clifton, R; Age: 46; Phone: 555-2110; Address: 361 Chander St., Springdale, VA; County: Columbia; Sex: Male; Race: White; Disease: Lyme Disease; Date of Onset: 8/1/2006; Lab Confirmed? Users can also be actively notified of breaking health events as they occur. Pro 5. For example, if one of the hypotheses under consideration is that persons who worked in the west wing were at greater risk of disease, do not define a case as illness among persons who worked in the west wing with onset between Instead, define a case as illness among persons who worked in the facility with onset between Then conduct the appropriate analysis to determine whether those who worked in the west wing were at greater risk than those who worked elsewhere. A communications plan must be established. Regardless of when the decision to conduct a field investigation is made, you should be well prepared before leaving for the field. Hypervitaminosis D associated with drinking milk. For example, contaminated foods should be discarded, and surgical equipment is routinely sterilized to prevent transmission. Conclusions In addition, investigators must consider logistical issues, such as how to contact potential controls, gain their cooperation, ensure that they are free of disease, and obtain appropriate exposure data from them. Hedberg CW, Fishbein DB, Janssen RS, Meyers B, McMillen JM, MacDonald KL, et al. Description: Floor plan showing the 6th floor of the Hart Building, S.E. : Yes; Hospital Alerted: Yes; Lab Results: WB IgM+, WB IgG+; Comments: Erythema migrans; Physician Reporting: Dr. Howard; Phone: 555-1950; Date of Report: 11/24/06. To interrupt vector borne transmission, measures may be directed toward controlling the vector population, such as spraying to reduce the mosquito population that may carry West Nile virus. The controls must not have the disease being studied, but should represent the population in which the cases occurred. Operational security (OPSEC) is an approach to risk management that promotes viewing operations from the perspective of an antagonist. Public health surveillance is "the ongoing, systematic collection, analysis, and interpretation of health-related data essential to planning, implementation, and evaluation of public health practice." Field Epidemiology These materials provide an overview of public health surveillance systems and methods. The plan should include how often and when to have conference calls with involved agencies, who will be the designated spokesperson, who will prepare health alerts and press releases, and the like. Children under five years age are among the population groups at considerably higher risk of contracting malaria and developing severe disease. Early (and continuing) analysis of descriptive data helps you to become familiar with those data, enabling you to identify and correct errors and missing values. Figure 6.3 Typical Epi Curves for Different Types of Spread. Since this technique is not precise, widen the probable period of exposure by, say, 20% to 50% on either side of these dates, and then ask about exposures during this widened period in an attempt to identify the source. N Engl J Med 2000;343;12237. Recover. For example, in the treatment of tuberculosis (TB), the relationship between the patient and the healthcare worker is extremely important because of the serious consequences of treatment failure. Adapted from: European Programme for Intervention Epidemiology Training [Internet]. But you'll need a plan. Later on, when hypotheses have come into sharper focus, the investigator may tighten the case definition by dropping the possible and sometimes the probable category. The cases that stand apart may be just as informative as the overall pattern. In addition, the p-value is exceedingly small, less than 0.001, and far less than the commonly used cutoff of 0.05. Source Ramsey AH, Belongia EA, Gale CM, Davis JP. Numbers indicate the burden of disease and are useful for planning and service delivery. data interpretation The process of reaching conclusions based on comparing the patient's presentation with information from your training, education, and past experiences. The lesson learned is that when the epidemiology does not fit the usual or natural patterns of transmission, investigators should think about intentional modes of transmission. Table 6.9 Standard Notation of a Two-By-Two Table. Emerg Infect Dis 2002;8:101928. They may be able to answer some critical questions: What were their exposures before becoming ill? Flourescein dye poured into the bathroom of the dorm found its way into the well water, revealing cross-contamination. Recognize, however, that the chi-square and similar tests are guides to help you make a decision about a hypothesis. Return to text. Tan C. A preventable outbreak of pneumococcal pneumonia among unvaccinated nursing home residents New Jersey, 2001. In a second study they compared restaurant exposures of case-patients and healthy restaurant patrons to identify a specific menu item, a meat and cheese sandwich. These clinical frequency distributions are considered so important in establishing the credibility of the diagnosis that they are frequently presented in the first table of an investigations report or manuscript. An investigation of an outbreak of SalmonellaMuenchen in Ohio illustrates how a reexamination of hypotheses can be productive.