![Page 1: Principles of Surveillance - Global Tobacco Control · Obesity −Health behaviors Smoking, sexual behavior, substance use ©2007 Johns Hopkins Bloomberg School of Public Health 16](https://reader034.vdocuments.site/reader034/viewer/2022052320/606f4353bf0d811d92789afa/html5/thumbnails/1.jpg)
Principles of Surveillance: Jonathan Samet, MD, MS
1
© 2007 Johns Hopkins Bloomberg School of Public Health
Principles of Surveillance
Jonathan Samet, MD, MSJohns Hopkins Bloomberg School of Public Health
2© 2007 Johns Hopkins Bloomberg School of Public Health
Learning Objectives
Define the basic terms related to surveillance
Specify characteristics of surveillance systems for differentobjectives
Describe selected major surveillance systems
![Page 2: Principles of Surveillance - Global Tobacco Control · Obesity −Health behaviors Smoking, sexual behavior, substance use ©2007 Johns Hopkins Bloomberg School of Public Health 16](https://reader034.vdocuments.site/reader034/viewer/2022052320/606f4353bf0d811d92789afa/html5/thumbnails/2.jpg)
Principles of Surveillance: Jonathan Samet, MD, MS
2
3© 2007 Johns Hopkins Bloomberg School of Public Health
Uses of Morbidity and Mortality Data
1. Hypothesis generation
2. Health planning
3. Program evaluation
4. Surveillance
4© 2007 Johns Hopkins Bloomberg School of Public Health
Surveillance
“Ongoing, systematic collection, analysis, and interpretationof health-related data essential to the planning,implementation, and evaluation of public health practice,closely integrated with the timely dissemination of these datato those responsible for prevention and control.”
— U.S. Centers for Disease Control and Prevention
![Page 3: Principles of Surveillance - Global Tobacco Control · Obesity −Health behaviors Smoking, sexual behavior, substance use ©2007 Johns Hopkins Bloomberg School of Public Health 16](https://reader034.vdocuments.site/reader034/viewer/2022052320/606f4353bf0d811d92789afa/html5/thumbnails/3.jpg)
Principles of Surveillance: Jonathan Samet, MD, MS
3
5© 2007 Johns Hopkins Bloomberg School of Public Health
Information Loop of Public Health Surveillance
Source: adapted by CTLT from http://www.cdc.gov/epo/dphsi/phs/overview.htm
6© 2007 Johns Hopkins Bloomberg School of Public Health
Immediate Detection of . . .
Epidemics− Established agents− Emerging agents
Newly emerging health problems
Changes in health practices
Changes in antibiotic resistance
Chemical and biological terrorism
Source: Thacker and Stroup. (1994).
![Page 4: Principles of Surveillance - Global Tobacco Control · Obesity −Health behaviors Smoking, sexual behavior, substance use ©2007 Johns Hopkins Bloomberg School of Public Health 16](https://reader034.vdocuments.site/reader034/viewer/2022052320/606f4353bf0d811d92789afa/html5/thumbnails/4.jpg)
Principles of Surveillance: Jonathan Samet, MD, MS
4
7© 2007 Johns Hopkins Bloomberg School of Public Health
Periodic Dissemination for . . .
Estimating the magnitude ofthe health problem, includingcosts
Assessing control activities
Setting research priorities
Testing hypotheses
Facilitating planning
Monitoring risk factors
Monitoring changes in healthpractices
Source: Thacker and Stroup. (1994).
8© 2007 Johns Hopkins Bloomberg School of Public Health
Source: Thacker and Stroup. (1994).
Archival Information for . . .
Describing the natural history of disease
Facilitating epidemiologic and laboratory research
Validating the use of preliminary data
Setting research priorities
Documenting distribution and spread
![Page 5: Principles of Surveillance - Global Tobacco Control · Obesity −Health behaviors Smoking, sexual behavior, substance use ©2007 Johns Hopkins Bloomberg School of Public Health 16](https://reader034.vdocuments.site/reader034/viewer/2022052320/606f4353bf0d811d92789afa/html5/thumbnails/5.jpg)
Principles of Surveillance: Jonathan Samet, MD, MS
5
9© 2007 Johns Hopkins Bloomberg School of Public Health
Langmuir on Surveillance
“Surveillance, when applied to a disease, means thecontinued watchfulness over the distribution and trends ofincidence through the systematic collection, consolidation,and evaluation of morbidity and mortality reports and otherrelevant data.”
— Alexander Langmuir
10© 2007 Johns Hopkins Bloomberg School of Public Health
From Vector to Agent to Disease: Surveillance Points
![Page 6: Principles of Surveillance - Global Tobacco Control · Obesity −Health behaviors Smoking, sexual behavior, substance use ©2007 Johns Hopkins Bloomberg School of Public Health 16](https://reader034.vdocuments.site/reader034/viewer/2022052320/606f4353bf0d811d92789afa/html5/thumbnails/6.jpg)
Principles of Surveillance: Jonathan Samet, MD, MS
6
11© 2007 Johns Hopkins Bloomberg School of Public Health
Points for Surveillance Example: Tobacco
12© 2007 Johns Hopkins Bloomberg School of Public Health
Modeling a Surveillance System
Source: Teutsch and Churchill. (2000).
![Page 7: Principles of Surveillance - Global Tobacco Control · Obesity −Health behaviors Smoking, sexual behavior, substance use ©2007 Johns Hopkins Bloomberg School of Public Health 16](https://reader034.vdocuments.site/reader034/viewer/2022052320/606f4353bf0d811d92789afa/html5/thumbnails/7.jpg)
Principles of Surveillance: Jonathan Samet, MD, MS
7
13© 2007 Johns Hopkins Bloomberg School of Public Health
Surveillance Systems: Some Characteristics
Geographic scale: local to global
Event identification: active or passive
Scope: all or sentinel events
Focus on monitoring: vector → agent → outcome
Purpose: tracking or alarm
14© 2007 Johns Hopkins Bloomberg School of Public Health
Modeling a Surveillance System
Source: Teutsch and Churchill. (2000).
![Page 8: Principles of Surveillance - Global Tobacco Control · Obesity −Health behaviors Smoking, sexual behavior, substance use ©2007 Johns Hopkins Bloomberg School of Public Health 16](https://reader034.vdocuments.site/reader034/viewer/2022052320/606f4353bf0d811d92789afa/html5/thumbnails/8.jpg)
Principles of Surveillance: Jonathan Samet, MD, MS
8
15© 2007 Johns Hopkins Bloomberg School of Public Health
Occurrence of an Event: Kind of Event
What kind of an event?− Exposure
Exposure to air pollution, bio-monitoring− Disease
Communicable diseases, chronic diseases, syndromes− Injuries
Motor vehicle accidents, homicide− Health risk factors
Obesity− Health behaviors
Smoking, sexual behavior, substance use
16© 2007 Johns Hopkins Bloomberg School of Public Health
What do you want to do a surveillance of?− Exposure
Agents Biomarkers
− Exposure determinants Behaviors Risk factors Vectors Host characteristics Reservoirs
− Health outcomes Disease Death Medical care
Occurrence of an Event: Surveillance of What?
![Page 9: Principles of Surveillance - Global Tobacco Control · Obesity −Health behaviors Smoking, sexual behavior, substance use ©2007 Johns Hopkins Bloomberg School of Public Health 16](https://reader034.vdocuments.site/reader034/viewer/2022052320/606f4353bf0d811d92789afa/html5/thumbnails/9.jpg)
Principles of Surveillance: Jonathan Samet, MD, MS
9
17© 2007 Johns Hopkins Bloomberg School of Public Health
WHO Global Tobacco Surveillance
World Health Survey− Household survey of adults (18+) conducted in 70 countries in
2002–2003
STEPwise Approach to Surveillance (STEPS)− Modular survey of chronic disease risk factors
Global Youth Tobacco Survey− School-based survey− Global Adult Tobacco Survey (planned)
18© 2007 Johns Hopkins Bloomberg School of Public Health
Occurrence of an Event: What Type of System?
What type of system would work best?− Universal: population tracking
Choose entire population or a representative sample tomonitor for condition of interest (measles, obesity,bioterrorism agents)
− Sentinel: “warning” signs Choose key “location” to monitor for condition of
interest (e.g., unusual disease) “Locations” might include sites, events, providers,
animals, vectors Choose a “location” that is most susceptible to change
![Page 10: Principles of Surveillance - Global Tobacco Control · Obesity −Health behaviors Smoking, sexual behavior, substance use ©2007 Johns Hopkins Bloomberg School of Public Health 16](https://reader034.vdocuments.site/reader034/viewer/2022052320/606f4353bf0d811d92789afa/html5/thumbnails/10.jpg)
Principles of Surveillance: Jonathan Samet, MD, MS
10
19© 2007 Johns Hopkins Bloomberg School of Public Health
Capturing an Event: Approaches
Active− Periodic solicitation of case reports from reporting sources,
such as physicians, hospitals, laboratories, etc.
Passive− Relies on health care providers to report on their own
initiative− Must make this reporting process simple and time efficient
20© 2007 Johns Hopkins Bloomberg School of Public Health
Active−Advantages
Can be very sensitive Can collect more
detailed information May be more
representative−Disadvantages
Costly Labor intensive Difficult to sustain
over time
Active vs. Passive: Advantages and Disadvantages
Passive−Advantages
Less costly Eager to design and
carry out Useful for monitoring
trends over time−Disadvantages
Low sensitivity Amount of data
available is limited May not be
representative
![Page 11: Principles of Surveillance - Global Tobacco Control · Obesity −Health behaviors Smoking, sexual behavior, substance use ©2007 Johns Hopkins Bloomberg School of Public Health 16](https://reader034.vdocuments.site/reader034/viewer/2022052320/606f4353bf0d811d92789afa/html5/thumbnails/11.jpg)
Principles of Surveillance: Jonathan Samet, MD, MS
11
21© 2007 Johns Hopkins Bloomberg School of Public Health
Active: SEER Cancer Registry
Source: http://seer.cancer.gov
22© 2007 Johns Hopkins Bloomberg School of Public Health
Passive: CDC Notifiable Diseases
Provisional Cases of Selected Notifiable Diseases, United States,Week Ending July 16, 2005*
Source: U.S. Centers for Disease Control. (2005).
* Incidence data for reporting year 2005 is provisional
ChlamydiaAIDSReporting Area
Cum. 2004Cum. 2005Cum. 2004Cum. 2005
9,89110,433374386South Carolina
15,19817,485333531North Carolina
1,4931,3503036West Virginia
11,73210,550329307Virginia
1,9101,970355467District of Columbia
10,0099,692686812Maryland
1,5141,72980100Delaware
91,83090,6876,0226,473South Atlantic
![Page 12: Principles of Surveillance - Global Tobacco Control · Obesity −Health behaviors Smoking, sexual behavior, substance use ©2007 Johns Hopkins Bloomberg School of Public Health 16](https://reader034.vdocuments.site/reader034/viewer/2022052320/606f4353bf0d811d92789afa/html5/thumbnails/12.jpg)
Principles of Surveillance: Jonathan Samet, MD, MS
12
23© 2007 Johns Hopkins Bloomberg School of Public Health
Modeling a Surveillance System
Source: Teutsch and Churchill. (2000).
24© 2007 Johns Hopkins Bloomberg School of Public Health
Processing and Analyzing the Event
How do you detect a signal?
Data capture/editing/management
Analytical approaches
Statistical approaches
![Page 13: Principles of Surveillance - Global Tobacco Control · Obesity −Health behaviors Smoking, sexual behavior, substance use ©2007 Johns Hopkins Bloomberg School of Public Health 16](https://reader034.vdocuments.site/reader034/viewer/2022052320/606f4353bf0d811d92789afa/html5/thumbnails/13.jpg)
Principles of Surveillance: Jonathan Samet, MD, MS
13
25© 2007 Johns Hopkins Bloomberg School of Public Health
Examine the Event by Person, Place, and Time
By person: demographics, lifestyle, risk factors
By place: GIS mapping
By time: epidemic curve, time series analysis
26© 2007 Johns Hopkins Bloomberg School of Public Health
By Place: GIS Mapping
GIS: geographic information systems− GIS links location to information (such as people to addresses,
buildings to parcels, or streets within a network) and layersthat information to give you a better understanding of how itall interrelates
− You choose what layers to combine based on your purpose
![Page 14: Principles of Surveillance - Global Tobacco Control · Obesity −Health behaviors Smoking, sexual behavior, substance use ©2007 Johns Hopkins Bloomberg School of Public Health 16](https://reader034.vdocuments.site/reader034/viewer/2022052320/606f4353bf0d811d92789afa/html5/thumbnails/14.jpg)
Principles of Surveillance: Jonathan Samet, MD, MS
14
27© 2007 Johns Hopkins Bloomberg School of Public Health
Image source: adapted by CTLT from U.S. Centers for Disease Control and Prevention. (2005).
By Time: Time Series
Time series analysis accounts for the fact that data points takenover time may have an internal structure (such as trend orseasonal variation) that should be accounted for
28© 2007 Johns Hopkins Bloomberg School of Public Health
By Person: Demographics
Age
Race/ethnicity
Occupation
Socioeconomic status
Sex
![Page 15: Principles of Surveillance - Global Tobacco Control · Obesity −Health behaviors Smoking, sexual behavior, substance use ©2007 Johns Hopkins Bloomberg School of Public Health 16](https://reader034.vdocuments.site/reader034/viewer/2022052320/606f4353bf0d811d92789afa/html5/thumbnails/15.jpg)
Principles of Surveillance: Jonathan Samet, MD, MS
15
29© 2007 Johns Hopkins Bloomberg School of Public Health
By Place
Small areas
Governmental units
Nations
Unit chosen to examine is determined by the availability of dataon particular geographic scales
30© 2007 Johns Hopkins Bloomberg School of Public Health
Source: U.S. National Cancer Institute. (1999).
Cancer Mortality Rates, by State
![Page 16: Principles of Surveillance - Global Tobacco Control · Obesity −Health behaviors Smoking, sexual behavior, substance use ©2007 Johns Hopkins Bloomberg School of Public Health 16](https://reader034.vdocuments.site/reader034/viewer/2022052320/606f4353bf0d811d92789afa/html5/thumbnails/16.jpg)
Principles of Surveillance: Jonathan Samet, MD, MS
16
31© 2007 Johns Hopkins Bloomberg School of Public Health
Heart Disease Death Rates: 1991–1995
Source: U.S. Centers for Disease Control and Prevention.
32© 2007 Johns Hopkins Bloomberg School of Public Health
Male Lung Cancer Incidence Rate per 100,000
Source: adapted by CTLT from GLOBOCAN. (2002). IARC.
![Page 17: Principles of Surveillance - Global Tobacco Control · Obesity −Health behaviors Smoking, sexual behavior, substance use ©2007 Johns Hopkins Bloomberg School of Public Health 16](https://reader034.vdocuments.site/reader034/viewer/2022052320/606f4353bf0d811d92789afa/html5/thumbnails/17.jpg)
Principles of Surveillance: Jonathan Samet, MD, MS
17
33© 2007 Johns Hopkins Bloomberg School of Public Health
Female Lung Cancer Incidence Rate per 100,000
Source: adapted by CTLT from GLOBOCAN. (2002). IARC.
34© 2007 Johns Hopkins Bloomberg School of Public Health
Modeling a Surveillance System
Source: Teutsch and Churchill. (2000).
![Page 18: Principles of Surveillance - Global Tobacco Control · Obesity −Health behaviors Smoking, sexual behavior, substance use ©2007 Johns Hopkins Bloomberg School of Public Health 16](https://reader034.vdocuments.site/reader034/viewer/2022052320/606f4353bf0d811d92789afa/html5/thumbnails/18.jpg)
Principles of Surveillance: Jonathan Samet, MD, MS
18
35© 2007 Johns Hopkins Bloomberg School of Public Health
Disseminating the Information
Process information for your audience− Broadcast faxes, email, mailings to dissemination lists
Locally, to clinicians Regionally, to health departments
− Web sites− Journal articles− Media
36© 2007 Johns Hopkins Bloomberg School of Public Health
Tobacco Use Information Systems
Global InfoBase− Data repository for chronic
disease risk factorprevalence, includingtobacco use
− Summarized inSurveillance of Risk FactorsReport (SuRF)
Global Information System onTobacco Control (GISTOC)− Provides links to tobacco-
related databases
Image source: World Health Organization. (2003 and 2005).
![Page 19: Principles of Surveillance - Global Tobacco Control · Obesity −Health behaviors Smoking, sexual behavior, substance use ©2007 Johns Hopkins Bloomberg School of Public Health 16](https://reader034.vdocuments.site/reader034/viewer/2022052320/606f4353bf0d811d92789afa/html5/thumbnails/19.jpg)
Principles of Surveillance: Jonathan Samet, MD, MS
19
37© 2007 Johns Hopkins Bloomberg School of Public Health
World Health Organization: The SuRF Report
Source: The World Health Organization.
38© 2007 Johns Hopkins Bloomberg School of Public Health
Modeling a Surveillance System
Source: Teutsch and Churchill. (2000).
![Page 20: Principles of Surveillance - Global Tobacco Control · Obesity −Health behaviors Smoking, sexual behavior, substance use ©2007 Johns Hopkins Bloomberg School of Public Health 16](https://reader034.vdocuments.site/reader034/viewer/2022052320/606f4353bf0d811d92789afa/html5/thumbnails/20.jpg)
Principles of Surveillance: Jonathan Samet, MD, MS
20
39© 2007 Johns Hopkins Bloomberg School of Public Health
Model for State-Based Chronic Disease Surveillance
Response
Hypothesis generation
Health planning
Program evaluation
Source: Remington and Goodman. (1999).
40© 2007 Johns Hopkins Bloomberg School of Public Health
Summary
Surveillance takeaways− Ongoing collection− Systematic according to a plan− Results given to those who need to know them− Resulting action is based in evidence gained in the
surveillance system