Surveillance

umo 08
Surveillance

Surveillance means to watch

over with great attention, and
often with suspicion
 Disease surveillance (WHO)
Disease S. is the continuous scrutiny of the
factors that determined the occurrence and
distribution of disease and other conditions of
ill health
 Surveillance is essential for effective control
and prevention
 It includes collection, analysis, interpretation
and distribution of relevant data for action
 Surveillance (Benenson)
 continuous scrutiny of
 all aspects of
 occurrence and
 spread
 of diseases
 that are pertinent to
 effective control
 Surveillance (CDC)
 The ongoing systematic collection , analysis,
and interpretation of health data essential
to the planning, implementation, and
evaluation of public health practice
 as well as the timely dissemination of these
data to those who need to know
 Key elements of definition

 Ongoing collection of data

 Timely analysis
 Interpretation
 Dissemination of results
 Action based on results
 Periodic evaluation of system
Role of public health surveillance
 the ultimate goal of surveillance is the use of
the data collected for the formulation of
policies and programs to promote health and
prevent disease
 is essential tool for measuring the impact of
preventive efforts
 systematic approach to data collection that
efficiency with regard to staffing and training
 Uses of surveillance system
1.To monitor change of trends in health factors
- prevalence, incidence of disease, and or
risk factors
- geographic distribution
- risk group distribution
2. To provide health information on which to
base rational intervention programs
- to assist in health planning
 Uses of surveillance system
3.To evaluate the effectiveness of intervention
strategic ( vaccine, HE, behavioral program)
4. To increase knowledge of vectors, animals
reservoirs, mode and dynamic of transmission
of communicable disease
5.Providing decision makers guidance for
disease prevention and control programs
 Epidemiological surveillance
 Nutritional S
 Demographic S
 Serological S
 Ecological S
 Surveillance of Ds
-Communicable ds
-Non communicable ds
 Public Health S
 Ten Major sources of ds surveillance
1. Mortality report from death certificate & health
facilities
2. Morbidity reports – from health facility eg.
Hospitals
3. Epidemic reports – from health facility and
community
4. Laboratory report – from Lab. (eg. MP slide)
5. Report of individual case investigation
6. Reports of epidemic investigation
7. Report of special surveys (AFP, goiter )
8. Information on animal reservoirs and vectors
9. Demographic data
10. Environmental data
 Components of surveillance
systems
 S of cases
 S of demographic changes
 S of animal reservoirs and vectors
 S of environmental factors
 Surveillance of case
 Data collection
- For each case, name, age, sex, occupation, address, date
of onset
- Report & register s/b reviewed
 Analysis and interpretation
- Specify freq. & distribution of occurrence of case
- by persons, time and place
- with maps. table, graph
 Source of infection & mode of transmission are
determined
 Contacts & population that might exposed are
identified & watch over
 Dissemination of information
- reporting, informing to authority,community,
- health person –DOH – MOH - WHO
data collection methods
 case classification
 Suspected case: Compatible clinical S/S but no laboratory evidence
of infection (negative, pending or not possible)
 Probable case: Compatible clinical signs and symptoms, and
additional
 epidemiological (e.g. contact with a confirmed case) or
 laboratory (e.g. screening test) evidence for the disease in question
 Confirmed case: Definite laboratory evidence of current or recent
infection, whether or not clinical signs or symptoms are or have been
present
 For meningococcal meningitis: confirmed case = suspected or probable case
laboratory confirmation
Collection and analysis of descriptive data
 Surveillance of Human pop.
1.Susceptibility of specific pop and subgroups
- Interview
- Serological survey
- Analysis of records
2.Occurrence of infection and unapparent infection
- Review of records & reports
- Special surveys( eg serological surveys)
- Cultural survey
- skin testing
3. Other demographic data
- Pop size, growth rate, internal and external movement
 Surveillance of animal population
1. Zoonosis
- Wild and domestic ( rodents, birds)
2. Surveillance of d/s agents (source) by
- Serological, bacterial, parasitological, vectors ,size of
animal population, identify species, subspecies, biotype,
pop. density ,season, anural breeding & feeding
 Surveillance of environmental
factors
 Contamination of water, milk, food ,air, ,excreta,
refuse
 Condition favorable for propagation or maintenance
eg. weather, rain
 Migration, urbanization and industrialization
 Ecological factors
 Natural disasters
 Behavioral surveillance
 Cultural,, custom, utilization, personal habit
and behavior
eg. HIV infection, Diarrhoea ,Malaria

Serological Surveillance
eg. HIV, VDRL
Diseases under national surveillance
(DUNS )- 21 d/s
 4 principal epidemic disease:
Severe diarrhoea (Cholera), DHF, Plague, AIDS
 6 EPI targeted ds: TB, Poliomyelitis, Diphtheria,
Pertussis, Neonatal Tetanus, Measles
 5 GI d/s : Diarrhoea, Dysentery, Food poisoning,
VH , Typhoid
 6 Other ds : Meningitis /Encephalitis,
ARI/Pneumonia, Malaria, Rabies , Snake bite,
Other Tetanus
 Current practice of D/s
surveillance in Myanma
 Routine surveillance
 Sentinel S
 Active S
 Hospital S ( passive )
 Specific epidemiological S
 Laboratory based S
 Vertical (campaign ) S
 Integrated diseases S ( HIV, TB )
 Special S Eg. after disaster, outbreak
Diseases under national
surveillance (DUNS )-
Cholera
 case: suspect, possible, confirmed
 sources of information: routine surveillance data; outbreaks
 hospital/ health center /
 carrier - acute & chronic
 investigation (lab: & special) & verification

 contact - contact surveillance

 Frequency, Time, Place, Person, Rate, Ratio

 source of infection

 mode of transmission
Population
 demographic data - growth rate
 over crowding
 pop movement/migration

 human behaviour - eating pattern (row sea food/fish

vegetable)
 poor sanitation/ lack of facility
 low standard & poor personal hygiene
Animal/ Vector
 fly→ population,  breeding space

global warning, environmental insanitation

Ecological
 contamination of water, food, milk

 after disaster (e.g. Flood, Equate, Tsunami)

Plaque
S is essential in areas with natural plague foci or with
history of past infection
 routine S done by RCSU (Rodent Control Special
Unit) & some SDCU (Mandalay, Magwe, Sagaing,
Shan)
 case → Bubonic/ pneumonic/ septic

- review of report, records death certificate,

freq/time place person
- lab: investigation & verification of case
- prompt treatment, isolation, and other
control measure
S of human pop.
 susceptibility of specific pop

 human activity → natural foci

- hunting/ grazing/ cultivation/

harvesting /
- war, refugees
- movement of people & cargo
- custom → collection & handling/ eating
of rodent
- Immunity -
S of animal pop.
 perform rodent and ectoparasites studies,
 size of pop., activities, species, m/m of both
domestic wild rodents.
 environmental sanitation

 Rat fall is notifiable, and

 if reported, surveillance of rodent

 and control of rodent and flea done.
S of vectors
 flea index,

S of agents
Bacteriology and serology surveillance

Environmental
 seasonal - winter month in central

raining month in colder region

 poor housing and
 refuse insanitary
DHF
 weekly report
 case – ice berg 1:150 – 200
seasonal – mid & late
cyclical – 2-3 years
 reservoir - man/monkey
 vector – aedes egypti
increase pop/breeding space
humidity/seasonal
behaviours (bite & rest)
1.Fever surveillance -
 Aetiological study of fever of unknown origin
(PUO)
2. Aedes surveillance -
(i) Adult survey
- survey to establish presence of vectors/pop:
density/ seasonal prevalence of Aedes - --
- vector resistance to insecticides
- landing rate
- indoor resting density
(ii) Larval survey
- House index = % of houses (+) ve for larvae
>50%  high transmission potentials

(iii ) Breteau index = No. of (+) ve containers per 100

houses

(iv) Ovitrap survey

- Ovitrap index = % of ovitraps found (+) ve for
eggs
Population
 < 12 year (exception)
 Activity of the children
 human behaviour – use of mosq. net

discard of used material

Ecological
 water supply/ storage

 rainy & breeding space

 humidity
AIDS
 Routine report - case
 Monthly report
 sentinel surveillence
 Population – movement, -
transportation,
- communication,
- behaviour
 Serological survey
 Sentinel surveillance in HIV
Sentinel surveillance of high-risk groups
-IVDU, CSW , males at STD clinic
if >5% - Action
for low-risk groups
- ♀at AN clinic , Blood donors , Rapid surveys
if 1-2% - Action
Actions - condom promotion
- HE
 Polio
 Reporting (Immediately)
 Investigation within 48 hr by medical off
 <5 child - Outbreak Response Immunization (ORI)
– 2 dose 1mth interval
 2 time stool sample (24-28) hr (within 14 day or 3
month)
 ice pack & label - NHL
 60 day – residual paralysis present or not
 Investigation form to CEU
AFP
 AFP cluster – high risk area –

reporting (immediately)
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 Surveillance of New emergent
Diseases
 H5N1
 occurrance of bird flu among wild and domestic
bird,
 Movement of Migratory bird

 Contact surveillance ( in farm, lab. )

 H1N1
 fever surveillance
 contact surveillance