DISEASE SURVEILLANCE
PRESENTED BY:MADAM AURALIA IGUNZA
DEFINITION OF TERMS
• Disease
A disease is an abnormal condition that negatively affects the function of part
or organism, and that is not due to external injury.
• Outbreak
A sudden increase in occurrences of a disease in a particular time and place
DEFINITION OF TERMS
• Investigation
Study of facts that are then used to inform decision.
• Outbreak investigation
Identification of source of disease in order to establish control and to institute
measures for preventing future episodes of a disease
DEFINITION OF TERMS
• Surveillance
It is the ongoing systematic collection, analysis, and interpretation of data for
planning, implementation, and evaluation.
• Disease surveillance
Information based activity involving the collection, analysis and interpretation of data
to evaluate the effectiveness of control and preventive health measures
Outbreak Detection
• Detecting an outbreak is the first step in investigating an outbreak.
• Outbreaks are detected by;
• Using surveillance method
• Formal reports of illness
• Informal reports of illness
Outbreak Detection
• If the index exceeds a critical value, then an epidemic will begin
• The index case is the patient in an outbreak who is first noticed, and who
makes people aware that an outbreak might be emerging.
• Epidemic is detected if the sensitivity, specificity and positive predictive
values show indications of an epidemic.
Types of epidemics
• Point source
An epidemic in which all cases are infected at the same time, usually from a
single source exposure.
A common example will be food from a single meal at an event.
In this type of outbreak, the number of cases rises rapidly to a peak and
decline gradually.
Types of epidemics
• Continuous source
An epidemic in which the causal agent is continuously infecting people who
come into contact with it, over an extended period of time.
Types of epidemics
• Person to person
• Is also called propagates.
• The causal agent is spread through person to person.
• For this reason, the epidemic may last longer and is more complicated to
contain.
Investigation of Epidemics/Outbreaks
Objectives of investigating epidemics
• Define magnitude of the epidemic (When, Whom, Where)
• Determine factors responsible for the epidemic (Why)
• Identify course, source of infection and modes of transmission (How)
• Implement control and preventive measures at the beginning of epidemic
Steps of epidemic Investigation
1. Prepare for field work
2. Establish the existence of an outbreak
3. Verify the diagnosis
4. Construct a working case definition
5. Find cases systematically and record information
6. Perform descriptive statistics
7. Develop hypotheses
8. Evaluate hypotheses epidemiologically
9. Implement control and prevention measures
10. Initiate or maintain surveillance
11. Communicate findings
Steps of Outbreak Investigation
Step One: Prepare Field work
By addressing scientific and investigative issues ( review literatures about the
issue), and management and operational issues (team formation and planning
for logistics)
Steps of Outbreak Investigation
• Step Two: Establish the existence of an outbreak
By checking reports if there are more cases than expected.
• Step Three: Verify Diagnosis
By reviewing the clinical findings and laboratory results
Steps of Outbreak Investigation
• Step four: Construct a working case definition
By designing standard set of criteria for deciding whether an individual should be
classified as having the health condition of interest.
• Step five: find cases systematically and record information
By conducting passive surveillance and active surveillance to collect identifying
information, demographic information, clinical information, risk factor information,
reporter information
Steps of Outbreak Investigation
• Step six: perform descriptive epidemiology
By characterizing the occurrence by time, place, and person
• Step seven: develop hypothesis
By addressing the source of the agent, the mode (and vehicle or vector) of
transmission, and the exposures that cause the disease. The hypotheses should be
testable, since evaluating hypothesis is the next step in the investigation
Steps of Outbreak Investigation
• Step Eight: Evaluate hypothesis epidemiologically
This is done by:
1. Comparing the hypothesis with the established facts by using analytic epidemiology
to quantify relationships and assess the role of chance
2. Using a combination of environmental evidence, laboratory science and
epidemiology.
Steps of Outbreak Investigation
Step Nine: Implement control and prevention measures
By:
1. Blocking the mode of transmission
2. Interrupting direct transmission through isolation, counselling and treatment
Steps of Outbreak Investigation
Step Ten: Initiate or maintain surveillance
Monitor effectiveness of the intervention through routine collection, analysis
and interpretation of data.
Step Eleven: Communicate findings
By giving oral briefing for local authorities and written reports
Control of epidemics
• In order to control epidemics, we must have information on:
• Causative organism
• Dynamics of disease transmission
• Modes of transmission
• Root of transmission
Control Epidemics
• 3 dynamics of disease prevention are applied;
➢Removal of source infection
➢Prevent transmission
➢Vector control measure
Control Epidemics
➢Prevent transmission
❖Isolation of infected cases
❖Hand washing and personal protective measures
❖Proper disposal of waste
❖Screening of suspected cases
❖Health education
❖Quarantine or migrated cases
❖Increase resistance through immunization
Control Epidemics
➢Vector control measure
❖Prevent breeding of vectors
❖Destruction of adult vectors through insecticide and pesticide
❖Personal protection from bites
❖Improve environmental sanitation
Purpose of surveillance
• Provide information for action
• Monitor disease trend
• Detecting outbreaks
• Determine program and resource needs
• Stimulate research
• Trigger disease control activities
• Reduce infection rate
• Establish epidemic baseline
• Evaluate disease prevention control measures
• Defend claims for malpractice
• Assess public health status
• Estimating the magnitude of a health problem
Types of surveillance
❖Passive Surveillance
A routine reporting system done at hospitals to gather disease data from all
potential reporting health workers.
Health authorities do not stimulate reporting by reminding health care
workers to report disease nor providing feedback to individual health workers.
Types of Surveillance
❖Active Surveillance
Provides stimulus to health care workers in the form of individual feedback or
other incentives.
Frequency of reporting by individual health workers is monitored.
Health workers who consistently fail to report or complete the forms
incorrectly are provided specific feedback to improve their perforance
Types of Surveillance
❖Sentinel Surveillance
Instead of attempting to gather surveillance data from all health care workers,
a sentinel surveillance system selects, either randomly or intentionally, a small
group of health workers from whom to gather data.
Sentinel surveillance also requires more time and resources, but can often
produce more detailed data on cases of illness because the healthcare workers
have agreed to participate and may receive incentives.
Components of surveillance
• Data collection
• Data analysis
• Data dissemination
• response
Sources of health surveillance data
• Health facilities registers
• Patient treatment notes
• Summary reports
• Notifications
• Activity reports
• Review of surveillance data
• Vital statistics and verbal autopsy
• Demographic surveillance types
• Disease registries
• Health surveys
• Sentinel systems
• Administrative data
• census
Strategies of surveillance
• Carry out surveillance that identifies and drives the promotion of health and well being
• Strengthen surveillance capacity and transform data into quality information and knowledge
• Creating surveillance system that fits into existing integrated disease surveillance
• Continuous improvement in surveillance methods through learning from local, national and international
experience
• Automation of routine collection, analysis and reporting of surveillance information
• Building surveillance systems that are adaptable and respond to changing needs in a timely manner
• Ensuring mechanisms are in place to be aware of new and re-emerging infectious diseases and possible
environmental health hazards.
Steps in surveillance
• Selection of topic and measure
• Identification of data sources and creation of indicators
• Data collection
• Data integration
• Data analysis
• Interpretation of results
• Development of surveillance report
• Dissemination of report
Attributes of a good surveillance system
• Simplicity of the system structure and operation
• Flexibility to look at questions posed by research and accommodate changes or
reporting definitions
• Data quality for complete and valid data
• Acceptability to generate willingness to participate in the system
• Sensitivity for capturing all monitoring trends
• Predictive value positive of capturing true cases
• Representativeness of the information for individuals in the study
Attributes of a good surveillance system
• Timeliness of process from collecting information to decision making
• Stability to reliably operate and provide information when called upon
• Collecting specific information that is required to achieve objectives for
disease control.
Disease threshold for Epidemics
• A threshold is a marker that alerts public health officials to take actions
• It uses past data to decide if an event is abnormal in order to identify possible
outbreaks using surveillance data
• Although there are internationally accepted signals that constitute an alert for
some conditions, there are no globally fixed criteria for all diseases to guide
outbreak detection
• Disease under elimination, e.g. a single case of poliomyelitis, guinea worm or ebola
constitutes an alert
Disease threshold for Epidemics
• Characteristics and settings of a population, such as overcrowded camp
settings of displaced populations at risk following man-made or natural
disasters.
• For high frequency, less severe infectious diseases, several cases are
normally expected in endemic settings and a single case is not abnormal.
However, we would want to know and investigate further when a disease
occurs at levels exceeding expectation by a significant amount.
Disease threshold for Epidemics
• A threshold helps us decide if what we are seeing is abnormal and needs to
be investigated further.
• Only when cases are clustering within a defined area o there is a substantial
increase in the occurrence of cases is follow up required.
Disease surveillance in Kenya
• The IDSR (Integrated Disease Surveillance Response) is defined as a
strategy for multi-disease surveillance of selected priority diseases or
conditions.
• It was established in Kenya in 2002
Purposes of IDSR Establishment in Kenya
• To ensure the availability of guidelines for IDSR
• To provide necessary technical support for strengthening national communicable disease
surveillance system
• Link the regional IDSR and the national IDSR
• Establish links with national Centres of Excellence (COE) regional and global networks for
disease surveillance
• Envisages all surveillance activities in a country as a common public service
• Links the community, health facility, county and national levels in disease control and
prevention
IDSR Priority Diseases
• Cholera
• Dysentery
• Plague
• Yellow fever
• Typhoid fever
• Meningococcal meningitis
• Measles
Disease earmarked for eradication
• Leprosy
• Poliomyelitis
• Neonatal tetanus
• Dracunculiosis
Diseases of public health importance
• Malaria
• New AIDS cases
• Tuberculosis
• Childhood pneumonia
• Childhood diarrhoea
• STI
Challenges faced by IDSR in Kenya
• Linkage to action is weak at lower levels due to lack of capacity for data analysis
• Weak reporting and communication system from health facilities to county/ central
surveillance unit
• Weak laboratory capacity and network
• Lack of quarantine and adequate isolation facilities
• Insufficient early warning systems for epidemic preparedness and response
• Little and non-involvement of the communities in surveillance
• Limited financial resources to strengthen surveillance and to support epidemic response
THANK YOU